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Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?
Medical Journal of Australia (2002)
  • Paul P. Glasziou , University of Queensland
  • Simon D. Eckermann , University of Sydney
  • Sarah E. Mulray , University of Sydney
  • R. John Simes , University of Sydney
  • Andrew J. Martin , University of Sydney
  • Adrienne C. Kirby , University of Sydney
  • Jane P. Hall
  • Susan Caleo , University of Sydney
  • Harvey D. White
  • Andrew M. Tonkin
Abstract

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.

Keywords
  • cholesterol-lowering therapy,
  • pravastatin,
  • cost-effectiveness
Publication Date
October 21, 2002
Publisher Statement
Published Version.

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
Citation Information
Paul P. Glasziou, Simon D. Eckermann, Sarah E. Mulray, R. John Simes, et al.. "Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?" Medical Journal of Australia Vol. 177 Iss. 8 (2002)
Available at: http://works.bepress.com/paul_glasziou/36/