The west of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin

Objective: To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia. Design: Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study. Subjects: Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study. Main outcome: Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained. Results: If 10 000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of pound 20m over 5 years. These benefits imply an undiscounted gain of 2460 years of life, and thus pound 8121 per life year gained, or pound 20 375 per life year gained if benefits are discounted, Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (pound 5601 per life year gained (undiscounted) and pound 13 995 per life year gained (discounted)). Conclusions: In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.