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Cholesterol‐lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: is it cost‐effective?
Author(s) -
Glasziou Paul P,
Eckermann Simon D,
Mulray Sarah E,
Simes R John,
Martin Andrew J,
Kirby Adrienne C,
Caleo Susan,
Hall Jane P,
White Harvey D,
Tonkin Andrew M
Publication year - 2002
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2002.tb04883.x
Subject(s) - pravastatin , medicine , myocardial infarction , angina , cost effectiveness , quality adjusted life year , quality of life (healthcare) , placebo , physical therapy , emergency medicine , cholesterol , risk analysis (engineering) , alternative medicine , nursing , pathology
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.