Impact of Preventive Treatment on Healthcare Use: A Modeling Study of Statin Treatment.

OBJECTIVES

Statin treatment's efficacy, safety, and cost-effectiveness are well accepted. We assessed statin treatment effects on primary and hospital inpatient care use.

METHODS

The UK Biobank population cohort with linked hospital admissions (N = 501 807) and primary healthcare data (N = 192 983) was used to estimate models of hospital admissions, hospital bed-days, primary care services (consultations, diagnostic and monitoring tests, and medication prescription items) associated with individual characteristics and occurrences of major vascular event (myocardial infarction, stroke, coronary revascularization, or vascular death), diabetes, cancer, and nonvascular death. These models were integrated into a validated cardiovascular disease (CVD) microsimulation model to simulate lifetime healthcare use without and with statin treatment in population categories by age (40-60 and 60-70 years) and prior CVD.

RESULTS

Over lifetime, statin treatment reduced major vascular event [7.5% (6.6%-8.5%) to 11.5% (10.2%-12.8%)], increased life-years [0.64 (0.46-0.81) to 0.94 (0.70-1.17)], and reduced per person-year rates of hospital bed-days [-0.016 (-0.030, -0.002) to -0.115 (-0.150, -0.081)] and medication prescription items [-0.002 (-0.196, 0.191) to -0.927 (-1.252, -0.602)]. Per person on statin treatment, cumulative use of each included healthcare service decreased in earlier years after statin initiation, although the reductions diminishing over time and transitioned into higher long-term use. Larger reductions and earlier transitions to increased net cumulative use were observed in older people and/or those with prior CVD.

CONCLUSIONS

Statin treatment reduces primary and hospital inpatient care by reducing CVD events, but over time the increased longevity with statin treatment is associated with additional healthcare use leading to greater long-term cumulative healthcare use.