Statins cost effective and linked to better health outcomes in older people

Statin treatment is cost effective and linked to better health outcomes in older people with or without previous cardiovascular disease, although the risk reductions were substantially smaller in the latter, reports a modelling on the lifetime benefits of these drugs among the over-70s, published online in the journal Heart.

The findings back consideration of these drugs for most over-70s, say the researchers.

Statins are used extensively to ward off heart attacks and strokes in middle-aged people, supported by strong evidence from clinical trials. But the evidence to back their use in older adults, especially those without a history of cardiovascular disease, is less definitive, so guidelines stop short of recommending these drugs for this group, explain the researchers.

But the UK’s ageing population means that the over-70s now make up around 30% of people over the age of 40, yet despite cardiovascular risk increasing with age, statin use is lower among the over-70s.

The researchers therefore modelled the lifetime effects and cost-effectiveness of statin therapy for people aged 70 and above using the latest evidence on these drugs’ safety and effectiveness in older people. 

They projected cardiovascular risks, survival, quality-adjusted life years (QALYs)---years lived in good health—and healthcare costs of statin use in 5103 people with previous cardiovascular disease and in 15,019 without.

Their calculations indicated that lifetime use of a standard statin (reducing low density ‘bad’ Cholesterol by 35%-45%) increased QALYs by 0.24–0.70, while higher intensity statin therapy (reduction of 45% or more) increased QALYs by a further 0.04–0.13. 

Use of statins was cost-effective with the cost per QALY gained below £3502 for standard therapy and below £11,778 for higher intensity therapy, which is well under the current threshold for good value interventions of about £20,000 per QALY gained, note the researchers..

Statins were still cost-effective after further in-depth analyses, although with a larger degree of uncertainty among older people without previous cardiovascular disease, among whom the reductions in risk were substantially smaller.

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that most participants were aged between 70 and early 80s, and that the model drew on volunteers which may limit generalisability. 

The results of recent clinical trials trials have also indicated a small excess of mild muscle symptoms in the first year of treatment although these were unlikely to materially affect cost-effectiveness.

Nevertheless, the researchers conclude: “This study reports that statin therapy is highly likely to be cost-effective in older people, although there was greater uncertainty among older people without [cardiovascular disease] in scenario analysis, with substantially smaller risk reductions with statin therapy.

“While further randomised evidence will be helpful, the robustness of these findings indicates that [most] older people are likely to benefit cost-effectively from statin therapy and should be considered for treatment.”