Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy?
Eur J Prev Cardiol
; 19(3): 474-83, 2012 Jun.
Article
em En
| MEDLINE
| ID: mdl-21460076
ABSTRACT
BACKGROUND:
While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients. METHODS ANDRESULTS:
Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose-response rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative.CONCLUSION:
Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças Cardiovasculares
/
Medicamentos Genéricos
/
Custos de Medicamentos
/
Inibidores de Hidroximetilglutaril-CoA Redutases
/
Prevenção Secundária
Tipo de estudo:
Clinical_trials
/
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Limite:
Humans
Idioma:
En
Revista:
Eur J Prev Cardiol
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Reino Unido