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

Abstract

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. The aim was to estimate the cost-utility of statin therapy following surgical resection for EAC from a UKNational Health Service (NHS) perspective. 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. 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. The cohort exposed to statins had lower costs and better QALY outcomes than the no statin cohort. Assuming a causalimprovement in disease outcomes following resection for EAC, statin therapy is very likely to be a cost-saving treatment.