Cost-Effectiveness of using Statins in the Primary and Secondary Prevention of Cardiovascular Diseases

Aim of the study Hypercholesterinaemia is considered to be one of the major risk factors for arteriosclerosis, and the use of statins as cholesterol lowering drug has extensively increased during the last years. Considering the large number of patients with hypercholesterinaemia, this increased use has an important economic impact. The objective of this study is to examine the cost-effectiveness of statin use in the primary and secondary prevention of cardiovascular diseases. Methods In an interdisciplinary health technology assessment project a systematic review of the literature was conducted to identify all relevant studies on primary and secondary prevention of cardiovascular diseases using statins based on a documented search and selection of the literature using predefined inclusion and exclusion criteria and assessing the quality of the included studies. Data on medical outcomes, costs and cost-effectiveness were extracted, and study characteristics and results of economic evaluations have been synthesised in evidence tables. Results The studies included in the economic evaluation estimated a cost-effectiveness ratio of 37,013 per life year gained within the context of primary prevention based on the West of Scotland Coronary Prevention Study (WOSCOPS). The cost-effectiveness ratio for secondary prevention ranged from 4,490 within the scope of LIPS modelling to 10,313 per life year gained based on the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA). Cost-benefit analyses calculated results between 4,671 per quality adjusted life year (QALY) gained in the Lescol Intervention Prevention Trial (LIPS) and 36,238 QALY gained based on different models using Cholesterol and Recurrent Events (CARE) data. Conclusions The cost-effectiveness ratios in the context of the studies for primary prevention based on data from WOSCOPS and AFCAPS are significantly higher than those for secondary prevention. These results yielded for secondary prevention can be interpreted as cost-effective. With regard to primary prevention, this must be regarded as limited and assessed in terms of the risk of a cardiac or cardiovascular event