The European Journal of Health Economics

, Volume 10, Issue 3, pp 255–265

Cost-effectiveness of intensive atorvastatin therapy in secondary cardiovascular prevention in the United Kingdom, Spain, and Germany, based on the Treating to New Targets study


    • i3 Innovus
  • Ankur Pandya
    • i3 Innovus
  • David Thompson
    • i3 Innovus
  • Paula Chu
    • i3 Innovus
  • Jennifer Graff
    • Pfizer Inc.
  • James Shepherd
    • University of Glasgow
  • Nanette Wenger
    • Emory University School of Medicine
  • Heiner Greten
    • Hanseatisches Herzzentrum Hamburg
  • Rafael Carmena
    • Universidad de Valencia
  • Michael Drummond
    • i3 Innovus
    • University of York
  • Milton C. Weinstein
    • i3 Innovus
    • Department of Health Policy and ManagementHarvard School of Public Health
Original Paper

DOI: 10.1007/s10198-008-0126-1

Cite this article as:
Taylor, D.C.A., Pandya, A., Thompson, D. et al. Eur J Health Econ (2009) 10: 255. doi:10.1007/s10198-008-0126-1


The Treating to New Targets (TNT) clinical trial found that intensive 80 mg atorvastatin (A80) treatment reduced cardiovascular events by 22% when compared to 10 mg atorvastatin (A10) treatment. We evaluated the cost-effectiveness of intensive A80 vs A10 treatment in the United Kingdom (UK), Spain, and Germany. A lifetime Markov model was developed to predict cardiovascular disease-related events, costs, survival, and quality-adjusted life-years (QALYs). Treatment-specific event probabilities were estimated from the TNT clinical trial. Post-event survival, health-related quality of life, and country-specific medical-care costs were estimated using published sources. Intensive treatment with A80 increased both the per-patient QALYs and corresponding costs of care, when compared to the A10 treatment, in all three countries. The incremental cost per QALY gained was € 9,500, € 21,000, and € 15,000 in the UK, Spain, and Germany, respectively. Intensive A80 treatment is estimated to be cost-effective when compared to A10 treatment in secondary cardiovascular prevention.


Cardiovascular disease Cholesterol lowering Cost-effectiveness Decision analysis Markov model Secondary prevention Statin therapy

JEL Classification


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© Springer-Verlag 2008