Direct Comparison of the A to Z and PROVE IT Trials

Brown, B. Greg

doi:10.1161/circulationaha.106.612374

Circulation

2006

DOI: 10.1161/circulationaha.106.612374

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Direct Comparison of the A to Z and PROVE IT Trials

B. Greg Brown

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Cited by 8 publications

(1 citation statement)

References 19 publications

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“…5,7 The ability to weight the clinical impact of such diverse end points would provide greater insight into the actual benefits achieved with a particular intervention. Moreover, although prior studies have shown that conventional-dose statin therapy is costeffective for high-risk patients compared with placebo, 8 -12 it remains unclear whether high-dose statin therapy provides incremental clinical benefit that is cost-effective beyond conventional-dose statin therapy.…”

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confidence: 99%

Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease

Chan¹,

Nallamothu²,

Gurm³

et al. 2007

Circulation

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Background-Recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). However, the actual benefit and cost-effectiveness of high-dose statin therapy are unknown. Methods and Results-We designed a Markov model to compare daily high-dose with conventional-dose statin therapy for hypothetical 60-year-old cohorts with ACS and stable CAD over patient lifetime. Pooled estimates for major clinical end points (all-cause mortality, myocardial infarction, stroke, rehospitalization, and revascularization) from relevant clinical trials were incorporated. Incremental benefit was quantified as quality-adjusted life-years (QALYs). Threshold analyses determined at what price difference high-dose statins would yield incremental cost-effective ratios below $50 000, $100 000, and $150 000 per QALY gained. In ACS patients, a high-dose versus conventional-dose statin strategy resulted in a gain of 0.35 QALYs. In threshold analyses, a high-dose statin strategy consistently yielded incremental cost-effective ratios below $30 000 per QALY even under conservative model assumptions. In stable CAD patients, a high-dose statin strategy yielded a gain of only 0.10 QALYs and was sensitive to model assumptions about statin efficacy. The daily cost difference between a high-and conventional-dose statin would need to be Ͻ$1.70, $2.65, and $3.55 to yield incremental cost-effective ratios below $50 000, $100 000, and $150 000 per QALY. Conclusions-High-dose statin therapy is potentially highly effective and cost-effective in patients with ACS. In patients with stable CAD, however, the cost-effectiveness of high-dose statin therapy is highly sensitive to model assumptions about statin efficacy and cost. Use of high-dose statins can be supported on health economic grounds in patients with ACS, but the case is less clear for patients with stable CAD.

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confidence: 99%

Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease

Chan¹,

Nallamothu²,

Gurm³

et al. 2007

Circulation

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Role of C-Reactive Protein in Coronary Risk Reduction: Focus on Primary Prevention

Gotto

2007

The American Journal of Cardiology

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Nonoptimal high-density lipoprotein cholesterol levels are highly prevalent in patients presenting with acute coronary syndromes and well-controlled low-density lipoprotein cholesterol levels

Felix-Getzik

Kuvin

Karas

2010

Journal of Clinical Lipidology

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Direct Comparison of the A to Z and PROVE IT Trials

Cited by 8 publications

References 19 publications

Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease

Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease

Role of C-Reactive Protein in Coronary Risk Reduction: Focus on Primary Prevention

Nonoptimal high-density lipoprotein cholesterol levels are highly prevalent in patients presenting with acute coronary syndromes and well-controlled low-density lipoprotein cholesterol levels

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