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Primary prevention with statin in middle-aged men ‘results in cost savings for NHS’

Primary prevention with a statin results in significant reductions in hospital admissions and net healthcare costs, suggests 15-year analysis of a landmark UK trial.

The study

Researchers have analysed long-term follow-up data from the landmark West of Scotland Coronary Prevention Study (WOSCOPS).

The original study, conducted in over 6,000 middle-aged men with hypercholesterolaemia but no CHD, showed that treatment with pravastatin 40 mg daily led to a significant 12% reduction in all-cause mortality and 15% reduction in CHD deaths compared with placebo.

In this analysis, the researchers examined data from this long-term follow-up on hospital admissions due to CHD and the impact on healthcare resource use, costs and quality of life by linking trial data with routinely collected health records.

The findings

Previous studies looking at the long-term impact of primary prevention with a statin on admissions and healthcare costs have been based on modelled extrapolations, but the WOSCOPS researchers have been able to calculate actual 15-year outcomes.

They found treating 1,000 hypercholesterolaemia patients with pravastatin for five years would prevent 163 cardiovascular inpatient stays, including 35 MIs, 11 strokes and 17 heart failure admissions, as well as 100 admissions for CHD procedures.

From this, they estimated that treatment of 1,000 patients for five years would save the NHS £710,000 – after taking into account the costs of pravastatin and monitoring – and result in a gain of 136 QALYs over 15 years. Subgroup analysis suggested that the cost savings and QALYs gained were similar at different levels of baseline 10-year predicted cardiovascular risk.

There was no difference in non-cardiovascular admissions or costs, including those related to diabetes or its complications, with statin versus placebo treatment. They suggest the benefits would be even greater with a more potent statin.

What this means for GPs

The researchers wrote: ‘Five years’ primary prevention of middle-aged men with a statin significantly reduces healthcare resource utilisation, is cost saving, and increases QALYs. Treatment of even younger, lower risk individuals is likely to be cost-effective.’

However, they cautioned: ‘There remains uncertainty in relation to the potential for increased risk of diabetes with treatment of more than five years duration.’

Eur Heart J 2013; available online 9 July 2013