Cost-Effectiveness of Lowering Cholesterol in Older Patients after Heart Attack

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The summary below is from the full report titled " Cost-Effectiveness of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Therapy in Older Patients with Myocardial Infarction." It is in the 16 May 2000 issue of Annals of Internal Medicine (volume 132, pages 780-787). The authors are D.A. Ganz, K.M. Kuntz, G.A. Jacobson, and J. Avorn.

What is the problem and what is known about it so far?

Statins are drugs used to lower cholesterol levels. Use of statin therapy to lower cholesterol levels in patients younger than 75 years of age who have had a previous heart attack (secondary prevention) is well accepted in the medical community. However, the use of statins in patients older than 75 years of age has not been well studied. Thus, little is known about the costs and benefits of secondary prevention with statins for patients in this age group.

Why did the researchers do this particular study?

To find out the relative costs and benefits of secondary prevention with statin drugs in patients older than 75 years of age.

Who was studied?

Using actual patients to answer this question would require studying many patients, with many different combinations of risk factors, over many years. Instead, the researchers used computers to simulate what would happen to a "virtual" group of 75- to 84-year-old patients who had had a past heart attack.

How was the study done?

The authors used information from studies of actual patients 65 to 75 years of age to estimate how statin treatment might affect the occurrence of heart attacks, strokes, and death in patients 75 to 84 years of age. They used a computer model to estimate how much treatment with a statin drug would cost for each additional quality-adjusted life-year (QALY) gained by treatment. These QALYs take into account how well a person is during the time that they are alive. Because actual information on patients in this age group is not available, the researchers studied the effect of varying the potential costs and benefits of statin treatment over a wide range.

What did the researchers find?

In patients 75 to 84 years of who had had a previous heart attack, statin therapy to lower cholesterol levels was estimated to cost approximately $18,800 per QALY saved. In 75% of the cases that the researchers created by varying the costs and benefits of treatment in their computer model, statin treatment cost less than $40,000 per QALY.

What were the limitations of the study?

This study was a computer simulation. We cannot be sure what the results would be with actual patients. The ratio of costs to benefits for statin treatment might be unfavorable if the drugs were substantially more expensive or substantially less effective at lowering cholesterol levels and decreasing the risk for heart attack, stroke, and death than the researchers estimated.

What are the implications of the study?

For people older than 75 years of age who have had a previous heart attack, the benefit of secondary prevention with statin drugs relative to the costs of using these drugs appears to compare favorably with the ratio of benefits to costs for other commonly used health interventions.