Cost-effectiveness of high-dose atorvastatin compared with regular dose simvastatin

Lindgren, Peter; Graff, Jennifer; Olsson, Anders; Pedersen, Terje J.; Jönsson, Bengt

doi:10.1093/eurheartj/ehm020

Cited by 52 publications

(42 citation statements)

References 18 publications

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“…The validity of this model is confirmed by a comparable estimation of costs and health outcomes in previous studies assessing the cost‐effectiveness of intensive LLT for all versus standard LLT for all 11, 12, 13, 14, 15. Also, we based our assumptions on recent peer‐reviewed literature and adjusted event probabilities and risk of death for the age and cardiovascular history of patients.…”

Section: Discussionmentioning

confidence: 70%

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Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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BackgroundA validated prediction model estimates the absolute benefit of intensive versus standard lipid‐lowering therapy (LLT) with statins on next major cardiovascular events for individual patients with coronary artery disease. We aimed to assess whether targeting intensive LLT therapy to coronary artery disease patients with the highest predicted absolute benefit is cost‐effective compared to treating all with standard or all with intensive LLT.Methods and ResultsA lifetime Markov model was constructed for coronary artery disease patients (n=10 000) with mean age 61 years. Number of major cardiovascular events, (non) vascular death, costs, and quality‐adjusted life years (QALYs) were estimated for the following strategies: (1) standard LLT for all (reference strategy); (2) intensive LLT for those with 5‐year absolute major cardiovascular events risk reduction (ARR) ≥3%, ≥2.3%, or ≥1.5% (corresponding to ≥20%, ≥15%, or ≥10% 5‐year major cardiovascular events risk); and (3) intensive LLT for all. With intensive LLT for those with ≥3% 5‐year ARR (13% of patients), 380 QALYs were gained for €2423/QALY. Using a threshold of ≥2.3% ARR (26% of patients), 630 QALYs were gained for €5653/QALY. Using a threshold of ≥1.5% ARR (56% of patients), 1020 QALYs were gained for €10 960/QALY. By treating all intensively, 1410 QALYs were gained (0.14 QALY per patient) for €17 223/QALY. With benefit‐based treatment, 0.16 to 0.17 QALY was gained per treated patient.ConclusionsIntensive LLT with statins for all coronary artery disease patients results in the highest overall QALY gain against acceptable costs. However, the number of QALYs gained with intensive LLT by statins in individual patients can be increased with selective benefit‐based treatment.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835

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Section: Discussionmentioning

confidence: 70%

“…Previous studies have shown that treating all patients with stable CAD with intensive LLT is a cost‐effective strategy 11, 12, 13, 14, 15. The costs and effects of treating patients with the highest predicted absolute benefit intensively and those with smaller benefit with standard therapy are unknown.…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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“…A detailed description of the model has been published (10). All patients start in the 'at risk' state.…”

Section: Methods Study Descriptionmentioning

confidence: 99%

“…Over the median follow-up of 4.8 years, mean LDL-C levels decreased from 3.15 mmol/L (121.5 mg/dL) at baseline to 2.69 mmol/L (104 mg/dL) for patients allocated simvastatin, and to 2.10 mmol/L (81 mg/dL) for patients allocated atorvastatin. Patients randomly assigned to high-dose atorvastatin experienced fewer major coronary events, defined as coronary death, nonfatal acute MI or cardiac arrest with resuscitation (hazard ratio [HR] An economic evaluation based on data collected during the IDEAL trial indicated that intensive lipid lowering with atorvastatin 80 mg would be cost-effective compared with treatment with generic simvastatin in Denmark, Norway and Sweden (10). In Finland, this strategy was found to be cost-effective in high-risk patients (10).…”

mentioning

confidence: 99%

“…Patients randomly assigned to high-dose atorvastatin experienced fewer major coronary events, defined as coronary death, nonfatal acute MI or cardiac arrest with resuscitation (hazard ratio [HR] An economic evaluation based on data collected during the IDEAL trial indicated that intensive lipid lowering with atorvastatin 80 mg would be cost-effective compared with treatment with generic simvastatin in Denmark, Norway and Sweden (10). In Finland, this strategy was found to be cost-effective in high-risk patients (10). Given the availability of generic simvastatin in Canada at an acquisition cost lower than that of atorvastatin, we questioned whether treatment with high-dose atorvastatin would represent a cost-effective use of health care resources in Canada.…”

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confidence: 99%

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Economic evaluation of high-dose (80mg/day) atorvastatin treatment compared with standard-dose (20mg/day to 40mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial

Wagner

Lindgren

Merikle

et al. 2009

Canadian Journal of Cardiology

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oBJECTIvEs: To assess the cost-effectiveness of high-dose atorvastatin versus standard-dose simvastatin treatment in patients with a history of MI from a Canadian societal perspective. METhoDs: In a within-trial analysis, end point-related events, resources used and productivity losses occurring during the IDEAL trial were aggregated by treatment arm on an intention-to-treat basis to calculate the incremental cost per event avoided. Additionally, quality-adjusted survival was projected using a lifetime Markov model. Transition probabilities, workdays lost, use of study medication and cardiovascular hospitalization rates were based on IDEAL trial data. Hospitalization, study medication and productivity costs were included. Probabilistic and deterministic sensitivity analyses were performed. rEsuLTs: Compared with standard-dose simvastatin, atorvastatin 80 mg led to 0.099 fewer events per patient and cost savings over 4.8 years of treatment. Over a lifetime horizon, atorvastatin 80 mg led to 0.023 qualityadjusted life years (QALYs) gained per patient at an incremental cost of $26,795/QALY gained. The incremental cost-effectiveness ratio remained below $50,000/QALY in 78% of 1000 simulations. Exclusion of indirect costs resulted in an incremental cost-effectiveness ratio of $38,834/QALY. Results were relatively sensitive to baseline age, but robust with respect to sex, baseline low-density lipoprotein cholesterol levels, diabetes status and hospitalization costs. ConCLusIon: From a Canadian societal perspective, high-dose atorvastatin is cost-effective compared with standard-dose simvastatin in patients with a previous MI.

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Cost‐effectiveness of empagliflozin in the UK in an EMPA‐REG OUTCOME subgroup with type 2 diabetes and heart failure

et al. 2020

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Aims Heart failure (HF) and type 2 diabetes (T2D), common co-morbidities, translate into worse patient prognoses and higher direct costs than for either condition alone. Empagliflozin has been shown to markedly reduce cardiovascular (CV) deaths and HF hospitalizations (HHF) in HF patients with T2D. This study evaluated the lifetime cost-effectiveness of supplementing standard of care (SoC) with empagliflozin, relative to SoC alone, in HF patients with T2D from the UK payer perspective. Methods and results An existing discrete-event simulation model was adapted for the economic evaluation. Risk equations developed from time-dependent parametric survival analyses using patient-level HF subpopulation data from the EMPA-REG OUTCOME trial were employed to predict CV and renal events. Non-CV death, utility weights, and costs were drawn from UK sources. Quality-adjusted life years (QALYs) and costs were discounted at 3.5% per annum. Relative to SoC, empagliflozin with SoC yielded fewer first HHF, recurrent HHF, CV death, and non-fatal myocardial infarction but more non-fatal stroke events. Empagliflozin with SoC vs. SoC alone was associated with increased average life expectancy (10.80 vs. 9.59 LYs) and quality of life (6.27 vs. 5.62 QALYs), though at higher lifetime cost (£18 197 vs. £16 829) per person, resulting in an incremental cost-effectiveness ratio of £2093 per QALY. The probability of empagliflozin being cost-effective in the HF subpopulation at a £20 000 per QALY willingness-to-pay threshold was 91%. Conclusions This analysis suggests that adding empagliflozin to SoC in HF patients with T2D constitutes a cost-effective use of UK healthcare resources and may provide long-term health benefits to patients.

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Cost-effectiveness of high-dose atorvastatin compared with regular dose simvastatin

Cited by 52 publications

References 18 publications

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Economic evaluation of high-dose (80mg/day) atorvastatin treatment compared with standard-dose (20mg/day to 40mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial

Cost‐effectiveness of empagliflozin in the UK in an EMPA‐REG OUTCOME subgroup with type 2 diabetes and heart failure

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