Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study

Disease areas:

• heart and blood vessels

Last updated:

2 July 2025

Author(s):

Borislava Mihaylova, Runguo Wu, Junwen Zhou, Claire Williams, Iryna Schlackow, Jonathan Emberson, Christina Reith, Anthony Keech, John Robson, Richard Parnell, Jane Armitage, Alastair Gray, John Simes, Colin Baigent, J Armitage, C Baigent, E Barnes, L Blackwell, R Collins, K Davies, J Emberson, J Fulcher, H Halls, WG Herrington, L Holland, A Keech, A Kirby, B Mihaylova, R O'Connell, D Preiss, C Reith, J Simes, K Wilson, M Blazing, E Braunwald, J de Lemos, S Murphy, TR Pedersen, M Pfeffer, H White, S Wiviott, M Clearfield, Downs, A Gotto, S Weis, B Fellström, H Holdaas, A Jardine, TR Pedersen, D Gordon, B Davis, C Furberg, R Grimm, S Pressel, JL Probstfield, M Rahman, L Simpson, M Koren, B Dahlöf, A Gupta, N Poulter, P Sever, H Wedel, RH Knopp, S Cobbe, B Fellström, H Holdaas, A Jardine, R Schmieder, F Zannad, DJ Betteridge, HM Colhoun, PN Durrington, J Fuller, GA Hitman, A Neil, E Braunwald, B Davis, CM Hawkins, L Moyé, M Pfeffer, F Sacks, J Kjekshus, H Wedel, J Wikstrand, C Wanner, V Krane, Franzosi, R Latini, D Lucci, A Maggioni, R Marchioli, EB Nicolis, L Tavazzi, G Tognoni, J Bosch, E Lonn, S Yusuf, J Armitage, L Bowman, R Collins, A Keech, M Landray, S Parish, R Peto, P Sleight, JJP Kastelein, TR Pedersen, R Glynn, A Gotto, JJP Kastelein, W Koenig, J MacFadyen, PM Ridker, A Keech, S MacMahon, I Marschner, A Tonkin, J Shaw, J Simes, H White, PW Serruys, G Knatterud, GJ Blauw, S Cobbe, I Ford, P Macfarlane, C Packard, N Sattar, J Shepherd, S Trompet, E Braunwald, CP Cannon, S Murphy, R Collins, J Armitage, L Bowman, R Bulbulia, R Haynes, S Parish, R Peto, P Sleight, P Amarenco, KM Welch, J Kjekshus, TR Pedersen, L Wilhelmsen, P Barter, A Gotto, J LaRosa, JJP Kastelein, J Shepherd, S Cobbe, I Ford, S Kean, P Macfarlane, C Packard, M Roberston, N Sattar, J Shepherd, R Young, H Arashi, R Clarke, M Flather, S Goto, U Goldbourt, J Hopewell, GK Hovingh, G Kitas, C Newman, Sabatine, GG Schwartz, L Smeeth, J Tobert, J Varigos, J Yamamguchi

Publish date:

10 September 2024

Journal:

Heart

PubMed ID:

39256053

DOI:

10.1136/heartjnl-2024-324052

Abstract

BACKGROUND: Cardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy for older people in the contemporary UK population using a recent meta-analysis of randomised evidence of statin effects in older people and a new validated CVD model.

METHODS: The performance of the CVD microsimulation model, developed using the Cholesterol Treatment Trialists’ Collaboration (CTTC) and UK Biobank cohort, was assessed among participants ≥70 years old at (re)surveys in UK Biobank and the Whitehall II studies. The model projected participants’ cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs (2021 UK£) with and without lifetime standard (35%-45% low-density lipoprotein cholesterol reduction) or higher intensity (≥45% reduction) statin therapy. CTTC individual participant data and other meta-analyses informed statins’ effects on cardiovascular risks, incident diabetes, myopathy and rhabdomyolysis. Sensitivity of findings to smaller CVD risk reductions and to hypothetical further adverse effects with statins were assessed.

RESULTS: In categories of men and women ≥70 years old without (15,019) and with (5,103) prior CVD, lifetime use of a standard statin increased QALYs by 0.24-0.70 and a higher intensity statin by a further 0.04-0.13 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3502/QALY for standard and below £11778/QALY for higher intensity therapy and with high probability of being cost-effective. In sensitivity analyses, statins remained cost-effective although with larger uncertainty in cost-effectiveness among older people without prior CVD.

CONCLUSIONS: Based on current evidence for the effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old.