Pharmacoeconomic evaluation of the effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes

Schwartz, Gregory G.; Ganz, Patricia A.; Waters, David D.; Arikian, Steven R.

doi:10.1016/j.amjcard.2003.06.009

Cited by 50 publications

(52 citation statements)

References 11 publications

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“…The specific benefits of intensive lipid lowering with statins in the early period after an ACS were well established by trials such as the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study, Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) Study and A to Z, [103][104][105] in which up to one-quarter of patients had diabetes. The Cholesterol Treatment Trialists' Collaborators (CTTC) meta-analysis showed that statins reduce major vascular events by approximately one-fifth per mmol/L reduction in LDL-C. 106 This benefit is seen in patients with diabetes, with similar reductions in those with vascular disease (relative risk 0.80; 95% CI 0.74-0.88) and those without (relative risk 0.73; 95% CI 0.66-0.82).…”

Section: Dyslipidaemia Managementmentioning

confidence: 99%

The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

Katz

Leiter

Mellbin

et al. 2014

Diabetes and Vascular Disease Research

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Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality in patients with acute coronary syndromes (ACS). Cardiometabolic risk factors, including hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, increased visceral fat and inflammation, are associated with increased risk in this population and represent potential targets for treatment. In this review, management strategies for patients with T2DM post-ACS, both in the acute-care setting and in the long-term, are discussed. Although the benefits of long-term, aggressive, multifactorial risk factor modification are well established, a significant burden of recurrent events remains and the search for novel strategies continues. Several studies are assessing the potential cardiovascular (CV) benefits and safety of various classes of newer agents. Of these, AleCardio (aleglitazar), Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care in Patients With Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE; alogliptin) and Evaluation of LIXisenatide in Acute Coronary Syndrome (ELIXA; lixisenatide) specifically address patients with type 2 diabetes post-ACS. The mechanisms of action of these new therapies and aims of the CV outcome studies are briefly reviewed. The prevalence of type 2 diabetes continues to increase worldwide highlighting the need for new strategies that address the complex underlying processes that drive atherosclerosis and CV events in this high-risk patient population.

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Section: Dyslipidaemia Managementmentioning

confidence: 99%

The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

Katz

Leiter

Mellbin

et al. 2014

Diabetes and Vascular Disease Research

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“…Although trial-based cost-effectiveness analyses of statins have been published previously (26)(27)(28)(29)(30)(31)(32)(33)(34)(35), they were based on placebo-controlled trials and, as such, did not compare different statin therapies. Previous attempts to comparatively assess the cost-effectiveness of different statin therapies had to rely on indirect comparisons, drawing data from disparate clinical (22).…”

Section: Discussionmentioning

confidence: 99%

“…Heart disease also affects patients at an individual level. Among those with angina, CHF or MI, approximately 17.4% report problems walking, 35.9% live with pain, 59.2% need help with activities of daily living, and 5.4% are not working because of illness or disability (3).…”

mentioning

confidence: 99%

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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“…In the MIRACL study 7 , 3086 patients with a non-STEMI or unstable angina were randomised to receive atorvastatin 80 mg/day or placebo with 96 hours of presentation, and they were then followed for 16 weeks. The relative risk of the composite endpoint of death, non-fatal myocardial infarction and symptomatic coronary ischaemia was 0.84 in those treated with atorvastatin.…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

Statins, percutaneous coronary intervention and myocardial infarction

Jones

2013

Current Medical Research and Opinion

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Pharmacoeconomic evaluation of the effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes

Cited by 50 publications

References 11 publications

The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

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

Statins, percutaneous coronary intervention and myocardial infarction

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