title: The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin.
abstract: OBJECTIVE
  To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia.
  
  
  METHODS
  Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study.
  
  
  METHODS
  Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study.
  
  
  RESULTS
  Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained.
  
  
  RESULTS
  If 10,000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of 20m Pounds over 5 years. These benefits imply an undiscounted gain of 2,460 years of life, and thus 8121 Pounds per life year gained, or 20,375 Pounds per life year gained if benefits are discounted. Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (5601 Pounds per life year gained (undiscounted) and 13,995 Pounds per life year gained (discounted)).
  
  
  CONCLUSIONS
  In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.
authors.affiliation: Caro Research, Concord, MA 01742, USA. jcaro@caroresearch.com
authors.forename: J
authors.initials: J
authors.lastname: Caro
authors.forename: W
authors.initials: W
authors.lastname: Klittich
authors.forename: A
authors.initials: A
authors.lastname: McGuire
authors.forename: I
authors.initials: I
authors.lastname: Ford
authors.forename: J
authors.initials: J
authors.lastname: Norrie
authors.forename: D
authors.initials: D
authors.lastname: Pettitt
authors.forename: J
authors.initials: J
authors.lastname: McMurray
authors.forename: J
authors.initials: J
authors.lastname: Shepherd
mesh_terms: D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use*; D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D006937:Hypercholesterolemia / Q000191:economics / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use*; D012606:Scotland; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D017035:Pravastatin