Cost-Effectiveness of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Therapy in Older Patients with Myocardial Infarction

  1. David A. Ganz, BA;
  2. Karen M. Kuntz, ScD;
  3. Gretchen A. Jacobson, BA; and
  4. Jerry Avorn, MD
  1. From Harvard Medical School, Brigham and Women's Hospital, and Harvard School of Public Health, Boston, Massachusetts.

    Abstract

    Background: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has proven efficacy in reducing the rate of coronary and cerebrovascular events in patients 75 years of age or younger with a history of myocardial infarction. However, in patients older than 75 years of age, the efficacy and potential cost-effectiveness of statins are unknown.

    Objective: To estimate the incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction.

    Design: Cost-effectiveness analysis.

    Data Sources: Published data from cohort studies.

    Target Population: Patients 75 to 84 years of age with a history of myocardial infarction.

    Time Horizon: Lifetime.

    Perspective: Societal.

    Intervention: Statin therapy.

    Outcome Measures: Life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness.

    Results of Base-Case Analysis: The incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction was $18 800 per quality-adjusted life-year (QALY).

    Results of Sensitivity Analysis: On the basis of a probabilistic sensitivity analysis, there is a 75% chance that statin therapy costs less than $39 800 per QALY compared with usual care. If the cost of statin therapy and efficacy of statin therapy at reducing myocardial infarction were set to their most favorable values, statin therapy cost $5400 per QALY; if cost and efficacy were set to their least favorable values, statin therapy cost $97 800 per QALY.

    Conclusions: The cost-effectiveness ratios of statin therapy in older patients with previous myocardial infarction are reasonable under a wide variety of assumptions about drug efficacy, drug cost, and rates of cardiac and cerebrovascular events. Pending results of randomized, controlled trials of secondary prevention in patients in this age group, statin therapy seems to be as cost-effective as many routinely accepted medical interventions in this setting.

    Article and Author Information

    • Acknowledgments: The authors thank Sue J. Goldie, MD, MPH, for helpful comments on an earlier draft of this manuscript and Sharon Hawley for assistance in the background research necessary for the preparation of this paper.

    • Grant Support: By a core grant to the Division of Pharmacoepidemiology and Pharmacoeconomics by Brigham and Women's Hospital, and by a research stipend from Harvard Medical School (Mr. Ganz).

    • Requests for Single Reprints: Jerry Avorn, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115.

    • Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

    • Current Author Addresses: Mr. Ganz and Dr. Avorn: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115.

    • Dr. Kuntz: Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115.

    • Ms. Jacobson: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.

    • Author Contributions: Conception and design: D.A. Ganz, G.A. Jacobson, J. Avorn.

    • Analysis and interpretation of the data: D.A. Ganz, G.A. Jacobson, J. Avorn.

    • Drafting of the article: D.A. Ganz, G.A. Jacobson, J. Avorn.

    • Critical revision of the article for important intellectual content: D.A. Ganz, K.M. Kuntz, J. Avorn.

    • Final approval of the article: D.A. Ganz, K.M. Kuntz, G.A. Jacobson, J. Avorn.

    • Statistical expertise: K.M. Kuntz.

    • Collection and assembly of data: D.A. Ganz.

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    1. Ann Intern Med May 16, 2000 vol. 132 no. 10 780-787
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