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


CONCLUSIONS
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.
Franco
Oscar H
OH
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Netherlands. oscar.franco@unilever.com
Steyerberg
Ewout W
EW
Peeters
Anna
A
Bonneux
Luc
L
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015993:Life Tables; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors