Atorvastatin

Abstract

Atorvastatin is a lipid-lowering agent that has been evaluated in a number of primary and secondary intervention studies. In the primary prevention trials ASCOT-LLA and CARDS, atorvastatin 10 mg/day significantly reduced cardiovascular events compared with placebo. A prospectively conducted economic analysis of the 3.3-year ASCOT-LLA trial showed that atorvastatin was associated with incremental cost-effectiveness ratios (ICERs) of euro11,693 (UK) and euro12,673 (Sweden) per event avoided (2002 values). Longer-term modelled analyses using data from CARDS showed ICERs of euro8046 (Spain) and 6471pound (UK) per QALY gained (2003/2004 values), and a US analysis showed atorvastatin was dominant versus no statin when modelled over the lifetime of a representative US diabetic primary prevention population. In a modelled analysis based on results of the IDEAL trial, which showed significant reductions in cardiovascular endpoints with high-dose atorvastatin (80 mg/day) compared with conventional-dose simvastatin in patients with stable coronary heart disease, ICER values were below the commonly used cost-effectiveness threshold of euro50,000 per QALY gained in Norway, Sweden and Denmark, but were above this threshold in Finland (2005 values). A modelled US analysis that also included data from IDEAL and other sources showed an ICER of $US33,400 per QALY gained, assuming the incremental difference in acquisition cost between high-dose atorvastatin and conventional-dose simvastatin was $US1.40/day (2005 value). Most cost-effectiveness analyses with atorvastatin in patients with acute coronary syndrome used data from the 16-week MIRACL study, which showed a significant reduction in cardiovascular events with high-dose atorvastatin compared with placebo. Analyses were conducted in North America and Europe and showed that 31-86% of the acquisition cost of high-dose atorvastatin was offset by reductions in costs associated with cardiovascular events. Across five countries, ICER values ranged from approximate $US850 to $US4100 per event avoided (2000/2001 values). Another analysis conducted in the US used longer-term data and showed that high-dose atorvastatin versus conventional-dose statin was associated with an ICER of $US12,900 per QALY gained, assuming the daily difference in acquisition cost was $US1.40 (2005 value). In conclusion, atorvastatin has demonstrated beneficial effects on various cardiovascular endpoints in large, well designed primary and secondary intervention trials. These benefits in moderate- to high-risk patients were achieved at a relatively low incremental cost and, across the economic analyses, a substantial proportion of atorvastatin acquisition costs was offset by reductions in healthcare resource use associated with cardiovascular events. Cost-effectiveness analyses based on major clinical trials comparing atorvastatin with placebo, usual medical care, simvastatin or pravastatin have generally shown that atorvastatin is associated with favourable ICER values, often well below commonly used cost-effe...

Is optometry ready for myopia control? Education and other barriers to the treatment of myopia

“…The financial barriers identified corroborate and extend previous findings that highlight clinicians are concerned that myopia control is expensive, timely, and occupies valuable chair time 23 .…”

“…Clinic based optometrists identified inadequate and insufficient education and training as well as a lack of availability of myopia control therapies as a fundamental justification for their reluctance to practise myopia control. This supports the results from Wolffsohn et al's survey that revealed, amongst other barriers, a lack of availability of and information on myopia control means that the majority of international practitioners still prescribe single-vision correction as the primary mode of management for myopic patients, even in countries where the control of myopia progression has become an important clinical goal 23 . The perceived lack of availability of myopia control management options highlights the need for further education and regulatory guidance.…”

“…In view of this, the suggestion by participating academics that myopia focused postgraduate education programmes be prioritised seems prudent and would empower clinicians to apply their knowledge and expertise in contact lens fitting, as well as other techniques, into a formal myopia control management routine. However, myopia control focused CET, as well as online myopia management courses and guidelines, have been available to eye care practitioners for a number of years 40,41 , yet practitioners still consider themselves too uninformed to expand their scope of practice (which, in Ireland, is defined as one's ability to practise according to one's knowledge, skills, competence and experience) 42 to include myopia control therapies 23 . Clinic based optometrists felt skill-based practical learning strategies would instigate the most effective change in professional clinical practice which should be recognised by any emergent CPD programmes.…”

“…Despite these advances, the majority of progressive myopes are still prescribed single vision spectacles, especially in countries outside of Asia [23][24][25][26] . There is a scarcity of published literature that examines the possible reasons for the very limited uptake of active myopia management.…”

“…There is a scarcity of published literature that examines the possible reasons for the very limited uptake of active myopia management. A search of various databases including MEDLINE, EMBASE, Google Scholar, Scopus, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov during the preparatory stages of this study revealed only three research papers and a round table discussion that explored the knowledge and attitudes of eye care professionals toward myopia and its control [23][24][25]27 . Rather than a lack of evidence for efficacy, the barriers appear largely attitudinal; eye-care practitioners consider the information required to implement myopia control techniques to be lacking, as well as reporting concerns about the safety, cost and availability of such measures 23 .…”