Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?

PP Glasziou, SD Eckermann, SE Mulray, RJ Simes, AJ Martin, AC Kirby, JP Hall, S Caleo, HD White, AM Tonkin

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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 $107730 (95% Cl, $68626-$209881) 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.

Original languageEnglish
Pages (from-to)428-434
Number of pages23
JournalMedical Journal of Australia
Volume177
Issue number8
Publication statusPublished - 21 Oct 2002
Externally publishedYes

Cite this

Glasziou, PP ; Eckermann, SD ; Mulray, SE ; Simes, RJ ; Martin, AJ ; Kirby, AC ; Hall, JP ; Caleo, S ; White, HD ; Tonkin, AM. / Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease : Is it cost-effective?. In: Medical Journal of Australia. 2002 ; Vol. 177, No. 8. pp. 428-434.
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title = "Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: Is it cost-effective?",
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 $107730 (95{\%} Cl, $68626-$209881) 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.",
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Glasziou, PP, Eckermann, SD, Mulray, SE, Simes, RJ, Martin, AJ, Kirby, AC, Hall, JP, Caleo, S, White, HD & Tonkin, AM 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, vol. 177, no. 8, pp. 428-434.

Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease : Is it cost-effective? / Glasziou, PP; Eckermann, SD; Mulray, SE; Simes, RJ; Martin, AJ; Kirby, AC; Hall, JP; Caleo, S; White, HD; Tonkin, AM.

In: Medical Journal of Australia, Vol. 177, No. 8, 21.10.2002, p. 428-434.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease

T2 - Is it cost-effective?

AU - Glasziou, PP

AU - Eckermann, SD

AU - Mulray, SE

AU - Simes, RJ

AU - Martin, AJ

AU - Kirby, AC

AU - Hall, JP

AU - Caleo, S

AU - White, HD

AU - Tonkin, AM

PY - 2002/10/21

Y1 - 2002/10/21

N2 - 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 $107730 (95% Cl, $68626-$209881) 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.

AB - 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 $107730 (95% Cl, $68626-$209881) 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.

M3 - Article

VL - 177

SP - 428

EP - 434

JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

IS - 8

ER -