caa a22 4500 606158766 CHVBK 20210128100621.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s10557-015-6584-7 doi (NATIONALLICENCE)springer-10.1007/s10557-015-6584-7 Long-term Cost-effectiveness of Statin Treatment for Primary Prevention of Cardiovascular Disease in the Elderly [Elektronische Daten] [Liang Lin, Monica Teng, Ying Zhao, Ai Khoo, Raymond Seet, Quek Yong, Tiong Yeo, Boon Lim] Purpose: This study aimed to evaluate the cost-effectiveness of statins for primary prevention of stroke and myocardial infarction (MI) in the elderly in Singapore. Methods: A Markov model was developed to investigate the lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) of statin treatment in those aged 65years and older without a history of stroke or MI from the perspective of Singapore's healthcare system, using elderly-specific clinical data and local costs from hospital databases. A lifetime horizon was used and all costs and health outcomes were discounted at 3% annually. Results: In the base-case analysis, statin treatment prevented an additional four strokes and eight MIs among 1,000 "healthy” elderly individuals compared with no treatment. Statin treatment resulted in a QALY gain of 0.26 and additional costs of SGD 11,314 per person, yielding an ICER of SGD 43,925 (USD 33,495) per QALYgained. The results were sensitive to statin effectiveness, particularly statins' effect on all-cause mortality, and cost of statin medication. Probabilistic sensitivity analysis demonstrated that the probability of statin treatment being cost-effective was 72% at a willingness-to-pay threshold of SGD 65,000 (USD 49,546) per QALY gained. Shortening the time horizon from lifetime to 10years (simulating limited life expectancy) considerably increased the ICER to SGD 291,313 (USD 167,171) per QALY. Female gender and younger age were also associated with higher ICERs owing to a lower baseline risk of cardiovascular disease (CVD) and higher costs to manage events in these subgroups. Conclusions: Statin treatment for the primary prevention of CVD in the elderly was cost-effective. However, treatment warrants re-evaluation when the prognosis of the individual is considered less thantenyears; other goals may take precedence over CVD prevention. Springer Science+Business Media New York, 2015 Statins nationallicence Cost-effectiveness nationallicence Primary prevention nationallicence Cardiovascular disease nationallicence Elderly nationallicence Lin Liang Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut Teng Monica Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut Zhao Ying Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut Khoo Ai Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut Seet Raymond Department of Neurology, National University Hospital, Singapore, Singapore aut Yong Quek Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore aut Yeo Tiong Department of Cardiology, National University Heart Centre, Singapore, Singapore aut Lim Boon Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut Cardiovascular Drugs and Therapy Springer US; http://www.springer-ny.com 29/2(2015-04-01), 187-197 0920-3206 29:2<187 2015 29 10557 https://doi.org/10.1007/s10557-015-6584-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10557-015-6584-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lin Liang Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut NATIONALLICENCE 700 1- Teng Monica Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut NATIONALLICENCE 700 1- Zhao Ying Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut NATIONALLICENCE 700 1- Khoo Ai Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut NATIONALLICENCE 700 1- Seet Raymond Department of Neurology, National University Hospital, Singapore, Singapore aut NATIONALLICENCE 700 1- Yong Quek Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore aut NATIONALLICENCE 700 1- Yeo Tiong Department of Cardiology, National University Heart Centre, Singapore, Singapore aut NATIONALLICENCE 700 1- Lim Boon Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, 138543, Singapore, Singapore aut NATIONALLICENCE 773 0- Cardiovascular Drugs and Therapy Springer US; http://www.springer-ny.com 29/2(2015-04-01), 187-197 0920-3206 29:2<187 2015 29 10557