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Adjuvant Statin Therapy for Esophageal Adenocarcinoma: A Cost-Utility Analysis

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Abstract

Background

Emerging preclinical evidence indicates statins, medications commonly used in the prevention of cardiovascular disease (CVD), inhibit proliferation, promote apoptosis and limit invasiveness of esophageal adenocarcinoma (EAC). Population-based observational data demonstrate statin treatment after diagnosis of EAC is associated with significant reductions in all-cause and cancer-specific mortality. A feasibility study of adjuvant statin therapy following potentially curative resection for EAC has been completed, with planned progression to a full phase III, randomized controlled trial.

Objective

The aim was to estimate the cost-utility of statin therapy following surgical resection for EAC from a UK National Health Service (NHS) perspective.

Methods

A Markov model was developed to estimate the costs and outcomes [quality-adjusted life years (QALYs)] for hypothetical cohorts of patients with EAC exposed or not exposed to statins following potentially curative surgical resection. Model parameters were based on estimates from published observational and trial data. Costs, utilities and transition probabilities were modeled to reflect clinical practice from a payer’s perspective. Probabilistic and one-way sensitivity analyses were performed to account for uncertainty in key parameters.

Results

Overall, a cost saving of £6781 per patient was realized with statin treatment compared to no statins. In probabilistic sensitivity analysis, 99% of all iterations were cost saving and 99% of all iterations were less than £20,000 per QALY gained. These results were robust to changes in the price and effectiveness of statins.

Conclusions

The cohort exposed to statins had lower costs and better QALY outcomes than the no statin cohort. Assuming a causal improvement in disease outcomes following resection for EAC, statin therapy is very likely to be a cost-saving treatment.

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Authors and Affiliations

  1. Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, James Watson Road, Norwich Research Park, Norwich, NR4 7UQ, UK

    Rebekah Fong Soe Khioe, Chris Skedgel, Andrew Hart & Leo Alexandre

  2. Department of Gastroenterology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Andrew Hart, Michael Philip Nelson Lewis & Leo Alexandre

Authors
  1. Rebekah Fong Soe Khioe
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  2. Chris Skedgel
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  4. Michael Philip Nelson Lewis
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  5. Leo Alexandre
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Contributions

RFSK, CS, LA, AH and ML contributed to the writing and revision of the final manuscript. CS designed the model, with RFSK and LA contributing to the collection and analysis of data.

Corresponding author

Correspondence to Rebekah Fong Soe Khioe.

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Funding

The authors did not receive any grant support.

Conflict of Interest

R.FSK, C.S., L.A., A.H. and M.L. have no conflicts of interest to declare.

Data Availability Statement

The data and model are available on request from the corresponding author.

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Fong Soe Khioe, R., Skedgel, C., Hart, A. et al. Adjuvant Statin Therapy for Esophageal Adenocarcinoma: A Cost-Utility Analysis. PharmacoEconomics 36, 349–358 (2018). https://doi.org/10.1007/s40273-017-0594-1

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  • DOI: https://doi.org/10.1007/s40273-017-0594-1

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