What role for statins? A review and economic model.

Abstract

et al. What role for statins? A review and economic model. Health Technol Assess 1999;3(19). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Pharmaceutical Panel and funded as project number 96/14/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Prescribing in general practice for people with coronary heart disease; equity by age, sex, ethnic group and deprivation

“…Early trial evidence was limited to people aged under 70 years (Scandinavian Simvastatin Survival Study Group 1994) which may have been partly responsible for lower levels of prescribing in people over this age, as described in earlier studies (Robson 2008). However, more recent research in both the UK and elsewhere still shows that individuals over the age of 75 are prescribed 40Á90% less than younger age groups despite evidence that statin treatment can be beneficial in older patients (Ebrahim et al 1999, Reid et al 2002, Ward et al 2004, Hippisley-Cox et al 2005, Ramsay et al 2005, Gnavi et al 2007. Ecological studies have found that practices with a greater proportion of patients over the age of 75 tend to prescribe fewer statins (Ashworth et al 2007).…”

A review of health care models for coronary heart disease interventions

“…Several assumed that there would be no continued benefit after the trial end point or a coronary event [83,91,93,100]. Others assumed that treatment benefits would continue indefinitely [30,85,95,96,101]. One solution is to provide results on both possible extremes, as done by Tsevat et al [111].…”

“…The problem with using trial data is that it is not possible to generalise the results to different populations. Several models [85,95,96] assume that non-fatal events and health cost savings are proportional to the mortality benefit seen. Most studies measured the outcome of life years saved, rather than quality adjusted life years saved.…”

“…Several studies [30,[83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100] have assessed the cost effectiveness of statins. Most used Markov models to estimate the long term or lifetime prognosis of patients on statins, compared to those on placebo or no treatment.…”

“…Other studies used a particular statin but drew conclusion about the effectiveness of statins in general. Some studies have calculated the reduction in cholesterol levels and applied survival equations, for example the Framingham equations [86, 88-92, 97, 98], while others have applied risk reduction to the CHD event rate [30,83,85,93,95,96,100,101]. Several studies have simulated and then extended clinical trials, for example the CARE trial [100,101], PLAC I & II [83,93], 4S [91,101], LIPID [101], and LIPS [99].…”