Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: is it cost-effective?
OBJECTIVE
To measure the cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with established ischaemic heart disease and average baseline cholesterol levels.


METHODS
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.


METHODS
9014 patients aged 35-75 years from 85 centres in Australia and New Zealand, recruited from June 1990 to December 1992.


METHODS
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 $107 730 (95% CI, $68 626-$209 881) 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.
Glasziou
Paul P
PP
c/- Professor John Simes, NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, NSW 1450, Australia. p.glasziou@sph.uq.edu.au
Eckermann
Simon D
SD
Mulray
Sarah E
SE
Simes
R John
RJ
Martin
Andrew J
AJ
Kirby
Adrienne C
AC
Hall
Jane P
JP
Caleo
Susan
S
White
Harvey D
HD
Tonkin
Andrew M
AM
D000328:Adult; D000368:Aged; D001315:Australia; D002784:Cholesterol / Q000097:blood*; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D004311:Double-Blind Method; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D007902:Length of Stay; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D009520:New Zealand; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol; D017035:Pravastatin