This appendix contains cost–utility results from the statins model following the updates described in Chapter 6, General model updates, and subsequent inclusion of adjustment competing risk of non-cardiovascular death, as described in Chapter 6, New model features specific to this project.
Base case
State occupancy
provides model state occupancy graphs in two untreated cohorts with and without adjustment for competing risk of non-cardiovascular mortality. Both groups comprise 60-year-olds with a 10-year QRISK3-predicted risk of 10%, but one cohort is 100% male and the other cohort is 100% female.
State occupancy (no treatment) with and without adjustment for competing risk of non-cardiovascular mortality in example cohorts. (a) 60-year-old men, 10-year cardiovascular risk=10%: unadjusted for competing risk of non-cardiovascular mortality; (b) (more...)
Deterministic incremental cost–utility results
replicates Table 97 in appendix L of CG181,10 showing estimated costs and QALYs for each statin strategy and no treatment. also gives NHB for each arm (valuing QALYs at £20,000 each).
Updated model, including adjustment for competing risk of non-cardiovascular death: cost–utility results in men and women at various levels of non-cardiovascular risk
In and , we depict the cost-effectiveness of statins for people of different ages and cardiovascular risks, and how adjusting for competing risk of non-cardiovascular death affects these results. Even before adopting this adjustment, the model suggests that statins represent a good use of resources for almost everyone. It is only for people aged > 60 years with the lowest cardiovascular risk that statins represent poor value for money. However, adjusting for competing risk of non-cardiovascular death removes even this small subgroup. In practice, the distinction is moot if QRISK3 is used to predict cardiovascular risk, as it is essentially impossible for people in those age brackets to have 10-year risks low enough to enter the cost-ineffective zone. If such people did exist, then they would have extraordinary life expectancy, which is why the adjusted model concludes that it would still be good value to offer them statins, as there is every chance that even the oldest people would live to realise their benefit.
Cost-effectiveness of high-intensity statins (atorvastatin 20 mg/day) compared with no treatment, as a function of age and cardiovascular risk. (a) Unadjusted (as per CG181); and (b) adjusted for competing risk of non-cardiovascular death.
Updated CG181 model (not accounting for competing risk or DTD): relationship between age and risk of non-cardiovascular death: cost-effectiveness of statins. (a) Men; and (b) women. Coloured area identifies option with highest net benefit when we value (more...)
With direct treatment disutility
We see the effect of differing DTD assumptions on the cost-effectiveness of statins across a range of ages and baseline cardiovascular event risks in .
Cost-effectiveness of high-intensity statins (atorvastatin 20 mg/day) compared with no treatment, as a function of age, cardiovascular risk and DTD. (a) No DTD; (b) diminishing DTD; (c) time-limited DTD; and (d) permanent DTD. 50 : 50 men : women. All (more...)
Deterministic sensitivity analysis
One-way sensitivity analysis
One-way sensitivity analyses are depicted in –.
Updated model, including adjustment for competing risk of non-cardiovascular death: one-way sensitivity analysis for high-intensity statins (atorvastatin 20 mg/day) compared with no treatment (60-year-olds, 50 : 50 men : women, 10% 10-year cardiovascular (more...)
Updated model, including adjustment for competing risk of non-cardiovascular death: one-way sensitivity analysis for medium-intensity statins (simvastatin 20 mg/day) compared with low-intensity statins (simvastatin 10 mg/day) (60-year-olds, 50 : 50 men (more...)
Updated model, including adjustment for competing risk of non-cardiovascular death: one-way sensitivity analysis for high-intensity statins (atorvastatin 20 mg/day) compared with medium-intensity statins (simvastatin 20 mg/day) (60-year-olds, 50 : 50 (more...)
Probabilistic sensitivity analysis
– illustrate the pairwise comparison between high-intensity statins (atorvastatin 20 mg/day) and no treatment with and without adjustment for competing risk of non-cardiovascular death when analysed probabilistically.
Probabilistic sensitivity analysis for high-intensity statins (atorvastatin 20 mg/day vs. no treatment) with and without adjustment for competing risk of non-cardiovascular death in example cohorts. (a) cost–utility scatterplot for 60-year-old (more...)
Updated model, including adjustment for competing risk of non-cardiovascular death: probabilistic incremental cost–utility scatterplot – high-intensity statins (atorvastatin 20 mg/day) compared with no treatment (60-year-olds, 50 : 50 (more...)
Updated model, including adjustment for competing risk of non-cardiovascular death: probabilistic cost–utility scatterplot for all options (60-year-olds, 50 : 50 men : women, 10% 10-year cardiovascular event risk).
Updated model, including adjustment for competing risk of non-cardiovascular death: cost-effectiveness acceptability curve (60-year-olds, 50 : 50 men : women, 10% 10-year cardiovascular event risk). Bold line shows cost-effectiveness acceptability frontier. (more...)
With direct treatment disutility
In , we show probabilistic versions of the pairwise comparison between high-intensity statins (atorvastatin 20 mg/day) and no treatment under varying DTD scenarios for a representative range of age risk profiles.
Probabilistic sensitivity analysis for high-intensity statins (atorvastatin 20 mg/day vs. no treatment) under varying DTD scenarios for example cohorts. (a) Cost–utility scatterplot for 50-year-olds, 50 : 50 men : women, 10-year cardiovascular (more...)
Scenario analysis
Pay-off time under varying direct treatment disutility assumptions
and show cumulative incremental QALYs over time for four example profiles across our four DTD scenarios.
Payoff time for high-intensity statins (atorvastatin 20 mg/day) compared with no treatment, for different example populations under different DTD scenarios. (a) Undiscounted cumulative incremental QALYs for 50-year-olds, 50 : 50 men : women, 10-year cardiovascular (more...)
Clinical effectiveness and cost-effectiveness of high-intensity statins, as a function of age and cardiovascular risk, with different levels of DTD (as absolute decrement) and competing risk of non-cardiovascular death. (a) Effectiveness (incremental (more...)
