A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels

Background: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. Results: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastafin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Engaging future engineers:pedagogy, policy & practice

Despite being frequently misrepresented as outdated or old fashioned (IMechE, 2009, p1), engineering is increasingly called upon to deal with some of societies biggest challenges including those associated with climate, infrastructure and security. In order to meet such challenges there needs to be a supply of engineering talent able to turn its collective mind to what is required. Yet at a time when demands for engineers able to provide innovative solutions to contemporary problems is possibly at its highest, the profession is plagued by shortages and an inability to attract young people (DIUS, 2008; RAE 2008; NSF, 2009). Although the current situation appears critical, potential future shortages of engineers means that unless action is taken urgently, matters will get worse during the next 20 to 30 years. For higher education, the challenge is how to change young peoples perceptions of engineering in such a manner that it is seen as a worthwhile and rewarding career. This paper considers this challenge, looking in detail at why young people fail to view engineering positively. A theoretical framework outlining the various real-life barriers and drivers is proposed. A critical analysis of current policy and practice suggests that in order to promote engineering as a profession that young people want to enter, both pedagogic and policy grounded solutions need to be found. By bringing together pedagogy and policy within an engineering framework the paper adds to current debates in engineering education whilst providing a distinctive look at what seems to be a recurring problem. © 2009 Authors.