mrcbhf heart protection strongstudystrong - economic evaluation.pptVIP

Economic evaluation of MRC/BHF Heart Protection Study Heart Protection Study Collaborative GroupUniversity of Oxford UK HPS: Eligibility criteria Increased risk of CHD death due to prior disease: Myocardial infarction or other CHD; Occlusive disease of non-coronary arteries; or Diabetes mellitus or treated hypertension Age 40-80 years Total cholesterol ? 3.5 mmol/l (? 135mg/dl) Statin or vitamins not considered clearly indicated or contraindicated by patient’s own doctors Cost-effectiveness analysis of allocation to 40mg daily simvastatin Based on within trial period only (mean 5 years) Costs for UK National Health Service (2001) Cost-effectiveness analyses undertaken: per major vascular event* avoided per vascular death avoided overall and in subgroups at differing absolute risk *first or subsequent heart attack, stroke  or revascularisation following randomisation Major vascular events (MVE) and vascular deaths per 1000 patients HPS: Methods of calculating costs Costs included Study simvastatin (40mg daily at ￡1/day) and any non-study statin Hospitalisations for all major and other  vascular events Costs excluded Non-statin drugs Hospitalisations for non-vascular events (no significant differences between groups) Primary and social care costs  (no data available in HPS) Mean costs per patient for statin use and hospitalisation for any vascular event Cost per MVE avoided: ￡11,000 (￡8-16,000) Cost per vascular death avoided: ￡66,000 (￡42-135,000) Assessing subgroup effects reliably Analyses in different subgroups indicate: Similar relative reduction in vascular events Similar relative reduction in costs of vascular events Similar absolute difference in statin treatment cost Hence, cost-effectiveness for subgroups estimated by applying overall treatment effects to placebo event rates and costs observed in each subgroup Cox model on baseline characteristics used to create 5 multivariate risk groups Vascular event cost-savings by ri