Effects of statin treatment on primary and hospital care use: a microsimulation model

Background: Statin treatment's efficacy, safety and cost-effectiveness are well accepted, but the long-term impact on healthcare use is not fully understood. We assessed statin treatment effects on primary and hospital care use over time. Methods: The UK Biobank population cohort with linked hospital admissions (N=501,807) and primary healthcare data (N=192,983) informed models of hospital admissions, hospital inpatient days, primary care services (consultations, diagnostic and monitoring tests, and medication prescription items) associated with individual characteristics and occurrences of myocardial infarction, stroke, coronary revascularization and vascular death. These models were integrated into a validated cardiovascular disease (CVD) microsimulation policy model to assess statin treatment effects on healthcare use in population categories by age (40-60 years and 60-70 years) and prior CVD history. Results: Statin treatment was associated with improved survival and lower rates of hospital admissions, hospital inpatient days and prescription items per person-year over lifetime. Compared to no treatment, healthcare use with statin treatment was lower in earlier years after initiation, these reductions diminished over time and transitioned into higher healthcare use. The number of years to net neutral effect (95%CI) ranged from 9 (7-12) to 17 (9-25) for consultations/tests, from 22 (17-28) to 38 (28-48) for prescription items/hospital admissions, and from 40 (30-47) to 51 (43-62) for hospital inpatient days. Earlier transitions were observed in older people and people with prior CVD history. Conclusions: Statin treatment reduces individual rates of hospital inpatient services and medication prescriptions but increases overall healthcare use driven by increased longevity and ageing.