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Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.
Mark, Daniel B; Knight, J David; Cowper, Patricia A; Davidson-Ray, Linda; Anstrom, Kevin J.
Afiliación
  • Mark DB; Outcomes Research Group, Duke Clinical Research Institute, Durham, NC 27715, USA. daniel.mark@duke.edu
Am Heart J ; 156(4): 698-705, 2008 Oct.
Article en En | MEDLINE | ID: mdl-18926150
BACKGROUND: In 10,001 patients with stable coronary artery disease (CAD) enrolled in the Treating to New Targets (TNT) trial, 80 mg/d of atorvastatin (high-dose regimen) reduced the composite primary end point of death from CAD, nonfatal myocardial infarction, resuscitation from cardiac arrest, or stroke by 22% relative to 10 mg/d (low-dose regimen). METHODS: We performed an economic analysis of this trial from the US perspective using hospital bills and Medicare physician fees to estimate costs for cardiovascular hospitalizations in all US patients (n = 5,308). Atorvastatin costs were assigned using a discounted average wholesale price. Cost-effectiveness was calculated as the within-trial incremental cost required to prevent one primary end point event with high-dose atorvastatin. RESULTS: During a mean 4.9-year follow-up, the high-dose arm had fewer potential end point cardiovascular hospitalizations (35% vs 41%, P < .001) and revascularization procedures (16% vs 22%, P < .001). The high-dose regimen was $1 per day more expensive. At the end of 5 years, cumulative incremental cost for the high-dose arm was $252 (95% CI-$722 to +$1,276). With an absolute reduction in the primary end point of 2.8 per 100 treated with the high-dose regimen, the cost to prevent one additional primary end point event was $8,964. CONCLUSION: High-dose atorvastatin treatment of 5 years had only a small net incremental cost because of reduced complications and procedures. The cost to prevent one additional primary end point event with high-dose therapy was similar to that for drug-eluting stents versus bare metal stents in stable CAD and for early invasive versus early conservative therapy in acute coronary syndromes.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pirroles / Enfermedad de la Arteria Coronaria / Evaluación de Resultado en la Atención de Salud / Inhibidores de Hidroximetilglutaril-CoA Reductasas / Ácidos Heptanoicos Tipo de estudio: Clinical_trials / Health_economic_evaluation / Observational_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Año: 2008 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pirroles / Enfermedad de la Arteria Coronaria / Evaluación de Resultado en la Atención de Salud / Inhibidores de Hidroximetilglutaril-CoA Reductasas / Ácidos Heptanoicos Tipo de estudio: Clinical_trials / Health_economic_evaluation / Observational_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Año: 2008 Tipo del documento: Article