Cost-Effectiveness Analysis of Atorvastatin versus Rosuvastatin in Primary and Secondary Cardiovascular Prevention Populations in Brazil and Columbia.

BACKGROUND: Latin America has witnessed a marked increase in cardiovascular (CV) disease, the leading cause of death in many countries. The benefits of lipid-lowering therapy to reduce CV-related events are widely accepted. Clinical evidence suggests that rosuvastatin is associated with slightly greater reductions in low-density lipoprotein cholesterol levels than is atorvastatin at comparable doses. Rosuvastatin, however, is often priced at a premium. OBJECTIVE: Our objective was to examine the cost-effectiveness of using atorvastatin versus rosuvastatin in reducing CV events in Brazil and Colombia using real-world prices. METHODS: A global Markov cohort model of primary and secondary CV prevention was developed and adapted to Brazilian and Colombian settings. The risks and costs of major CV events and efficacy, adherence, and costs of statins were considered. Total gains in life-years, quality-adjusted life-years, major CV events avoided, and costs over the lifetime horizon were estimated. Several dose comparisons were considered. RESULTS: In the Colombian analyses, differences in drug costs between therapies were considerable while outcomes were similar. The incremental cost per quality-adjusted life-year gained for rosuvastatin versus atorvastatin was more than $700,000 and $200,000 in primary and secondary prevention, respectively. Brazilian analyses found lower incremental cost-effectiveness ratios for rosuvastatin at some dose comparisons due to similar pricing between statins. Sensitivity analyses revealed that changes in treatment efficacy and adherence had the largest impact on results. CONCLUSIONS: In primary and secondary CV prevention, the efficacy advantage of rosuvastatin was minimal, while its acquisition cost was higher, particularly in Colombia. The incremental cost-effectiveness ratios were, therefore, generally in favor of atorvastatin being the cost-effective option.

Colombian Health System on its Way to Improve Allocation Efficiency-Transition from a Health Sector Reform to the Settlement of an HTA Agency.

Over the past 20 years, Colombia has invested major efforts in ensuring universal health care access to its citizens while facing epidemiological transition and demographic changes. The country, as any other region in the world, is challenged by financial constraints and market pressures for entry of new and frequently costly technologies. After the 1993 health sector reform, Colombian citizens are entitled to health care access via mandatory health insurance through a benefits plan. Inclusions to this plan were the first attempt to establish a formal methodology of health technology assessment. Later on, the dynamics of insurers, market pressure, reimbursement decisions, and judicial actions drove the government toward the formulation of an infrastructure to improve efficiency in the use of resources. This article accounts for the steps undertaken by the Colombian health system until the establishment of a health technology assessment body and outlines the most important issues that can be learned from this process.