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Effectiveness calculation in economic analysis: the case of statins for cardiovascular disease prevention

¹ Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
² Department of Epidemiology and Preventive Medicine, Monash University Central and Eastern Clinical School, Melbourne, Australia
³ Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium

Correspondence to:
Correspondence to:
Dr O H Franco
Unilever Corporate Research, Colworth House, Sharnbrook, Bedfordshire MK44 1LQ, UK; oscar.franco{at}unilever.com

Objectives: This report aimed to evaluate the calculation of estimates of effectiveness in cost effectiveness analyses of statins for cardiovascular disease prevention.

Methods: Methodological aspects were reviewed of seven primary studies (based on trial results) and 12 secondary modelling studies (extrapolated) on the cost effectiveness of statin treatment, published between 1995 and 2002. Estimates of life years gained were extracted and compared with estimates calculated using the Dutch male life table of 1996–2000.

Results: Of the seven primary modelling analyses, six showed all the essential data. They estimated that 3 to 5.6 years (average 4.6 years) of statin treatment resulted in 0.15 to 0.41 years (average 0.3 years) saved over a lifetime time horizon. In contrast none of the 12 secondary modelling studies provided transparent results. They assumed lifelong treatment, leading to life table estimations of 2.4 and 2.0 (undiscounted) years saved for 40 and 60 year olds, with peak savings at around the mean age of death: 75–80 years. With 5% discounting, these effects reduced to 0.4 and 0.8 years respectively.

Conclusion: Reporting of essential data and assumptions on statin treatment was poor for secondary modelling analyses and satisfactory for primary modelling studies. Secondary modeling studies made assumptions on long term effectiveness that were hard to justify with the available evidence, and that led to the majority of life years saved at high ages. Further standardisation in economic analyses is important to guarantee transparency and reproducibility of results.

Abbreviations: CHD, coronary heart disease; YLS, years of life saved; CEA, cost effective analysis; LE, life expectancy

Keywords: cost effectiveness analysis; statins; cardiovascular disease; primary modelling; secondary modelling

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