Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?
Glasziou, P.P., Eckermann, S.D., Mulray, S.E., Simes, R.J., Martin, A.J., Kirby, A.C., Hall, J.P., Caleo, S., White, H.D. & Tonkin, A.M. (2002). Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective? Medical Journal of Australia, 177(8), 428-434.
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© Copyright The Medical Journal of Australia, 2002
Objective: To measure the cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with established ischaemic heart disease and average baseline cholesterol levels.
Design: Prospective economic evaluation within a double-blind randomised trial (Long-Term Intervention with Pravastatin in Ischaemic Disease [LIPID]), in which patients with a history of unstable angina or previous myocardial infarction were randomised to receive 40 mg of pravastatin daily or matching placebo.
Patients and setting: 9014 patients aged 35–75 years from 85 centres in Australia and New Zealand, recruited from June 1990 to December 1992.
Main outcome measures: Cost per death averted, cost per life-year gained, and cost per quality-adjusted life-year gained, calculated from measures of hospitalisations, medication use, outpatient visits, and quality of life.
Results: The LIPID trial showed a 22% relative reduction in all-cause mortality (P < 0.001). Over a mean follow-up of 6 years, hospital admissions for coronary heart disease and coronary revascularisation were reduced by about 20%. Over this period, pravastatin cost $A4913 per patient, but reduced total hospitalisation costs by $A1385 per patient and other long-term medication costs by $A360 per patient. In a subsample of patients, average quality of life was 0.98 (where 0 = dead and 1 = normal good health); the treatment groups were not significantly different. The absolute reduction in all-cause mortality was 3.0% (95% CI, 1.6%–4.4%), and the incremental cost was $3246 per patient, resulting in a cost per life saved of $107 730 (95% CI, $68 626–$209 881) within the study period. Extrapolating long-term survival from the placebo group, the undiscounted cost per life-year saved was $7695 (and $10 938 with costs and life-years discounted at an annual rate of 5%).
Conclusions: Pravastatin therapy for patients with a history of myocardial infarction or unstable angina and average cholesterol levels reduces all-cause mortality and appears cost effective compared with accepted treatments in high-income countries.
Paul P. Glasziou, Simon D. Eckermann, Sarah E. Mulray, R. John Simes, Andrew J. Martin, Adrienne C. Kirby, Jane P. Hall, Susan Caleo, Harvey D. White, and Andrew M. Tonkin. "Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?" Medical Journal of Australia 177.8 (2002): 428-434.