title: Long-term impact on healthcare resource utilization of statin treatment, and its cost effectiveness in the primary prevention of cardiovascular disease: a record linkage study.
abstract: OBJECTIVE
  To assess the impact on healthcare resource utilization, costs, and quality of life over 15 years from 5 years of statin use in men without a history of myocardial infarction in the West of Scotland Coronary Prevention Study (WOSCOPS).
  
  
  METHODS
  Six thousand five hundred and ninety-five participants aged 45-54 years were randomized to 5 years treatment with pravastatin (40 mg) or placebo. Linkage to routinely collected health records extended follow-up for secondary healthcare resource utilization to 15 years. The following new results are reported: cause-specific first and recurrent cardiovascular hospital admissions including myocardial infarction, heart failure, stroke, coronary revascularization and angiography; non-cardiovascular hospitalization; days in hospital; quality-adjusted life years (QALYs); costs of pravastatin treatment, treatment safety monitoring, and hospital admissions.
  
  
  RESULTS
  Five years treatment of 1000 patients with pravastatin (40 mg/day) saved the NHS £710 000 (P < 0.001), including the cost of pravastatin and lipid and safety monitoring, and gained 136 QALYs (P = 0.017) over the 15-year period. Benefits per 1000 subjects, attributable to prevention of cardiovascular events, included 163 fewer admissions and a saving of 1836 days in hospital, with fewer admissions for myocardial infarction, stroke, heart failure and coronary revascularization. There was no excess in non-cardiovascular admissions or costs (or in admissions associated with diabetes or its complications) and no evidence of heterogeneity of effect over sub-groups defined by baseline cardiovascular risk.
  
  
  CONCLUSIONS
  Five years' primary prevention treatment of middle-aged men with a statin significantly reduces healthcare resource utilization, is cost saving, and increases QALYs. Treatment of even younger, lower risk individuals is likely to be cost-effective.
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.forename: Michele
authors.initials: M
authors.lastname: Robertson
authors.forename: Laura
authors.initials: L
authors.lastname: Marchbank
authors.forename: Julie
authors.initials: J
authors.lastname: Peacock
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Packard
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use*; D011322:Primary Prevention / Q000191:economics; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin
keywords: Cardiovascular outcomes; Cost effectiveness; Pravastatin; Primary prevention; Record linkage