Generic Atorvastatin, the Belgian Statin Market and the Cost-Effectiveness of Statin Therapy
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study examines how the market entry of generic atorvastatin influences the Belgian statin market and the cost-effectiveness of statin therapy.
Using IMS Health data, the Belgian 2000–2011 statin market was analyzed in terms of total expenditure, annual price of statin treatment, and patient numbers. A simulation analysis projected statin market shares from 2012 to 2015 following market entry of generic atorvastatin. This analysis was based on three scenarios regarding the number of patients taking specific statins. Savings associated with an atorvastatin price reduction of 50–70 % were calculated. A literature review of economic evaluations assessed the cost-effectiveness of generic atorvastatin.
Statin expenditure increased from €113 million in 2000 to €285 million in 2011 due to higher expenditure on atorvastatin and rosuvastatin. Although the number of patients treated with simvastatin increased by nearly 800 %, the resulting increase in expenditure was partially offset by price reductions. Atorvastatin is projected to become the dominant product in the Belgian statin market (market share of 47–66 % by 2015). Annual savings would attain €108.6–€153.7 million for a 50 % reduction in the atorvastatin price and €152.0–€215.2 million for a 70 % price reduction. The literature suggests that generic atorvastatin is cost-effective as compared to simvastatin. The limited evidence about the cost-effectiveness of rosuvastatin as compared with generic atorvastatin is inconclusive.
Generic atorvastatin is cost-effective as compared to simvastatin, is projected to become the dominant product in the Belgian statin market and is expected to generate substantial savings to health care payers.
- Chen Z, Peto R, Collins R, MacMahon S, Lu J, Li W. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ. 1991;303:276–82. CrossRef
- Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986;256:2823–8. CrossRef
- Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267–78. CrossRef
- Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol. 2012;59:572–82. CrossRef
- Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:2307–13. CrossRef
- Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81. CrossRef
- Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol. 2006;48:438–45. CrossRef
- Jackevicius CA, Chou MM, Ross JS, Shah ND, Krumholz HM. Generic atorvastatin and health care costs. N Engl J Med. 2012;366:201–4. CrossRef
- Health IMS. MIDAS database. London: IMS Health; 2012.
- Roberfroid D, Dubois C, Vrijens F, Camberlin C, Farfan M. Statins in Belgium: utilization trends and impact of reimbursement policies. Brussels: Belgian Healthcare Knowledge Centre; 2010.
- Drummond M, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2005. p. 9.
- Dylst P, Vulto A, Simoens S. Where a cheap medicine is not the same as a generic medicine: the Belgian case. J Pharm Heal Serv Res. 2011;2:185–9. CrossRef
- Adriaen M, De Witte K, Simoens S. Pricing strategies of originator and generic medicines following patent expiry in Belgium. J Generic Med. 2008;5:175–87. CrossRef
- National Institute for Health and Disability Insurance. Top 25 of active substances in terms of public expenditure in ambulatory care in 2010. Brussels: National Institute for Health and Disability Insurance; 2012.
- Annemans L, Marbaix S, Webb K, Van GL, Scheen A. Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population. Clin Drug Investig. 2010;30:133–42. CrossRef
- Ara R, Pandor A, Stevens J, Rafia R, Ward S, Rees A, et al. Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy? Eur J Cardiovasc Prev Rehabil. 2011.
- Conly J, Clement F, Tonelli M, Hemmelgarn B, Klarenbach S, Lloyd A, et al. Cost-effectiveness of the use of low- and high-potency statins in people at low cardiovascular risk. CMAJ. 2011;183:E1180–8. CrossRef
- Gandhi SK, Jensen MM, Fox KM, Smolen L, Olsson AG, Paulsson T. Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events. Clinicoecon Outcomes Res. 2012;4:1–11. CrossRef
- Grabner M, Johnson W, Abdulhalim AM, Kuznik A, Mullins CD. The value of atorvastatin over the product life cycle in the United States. Clin Ther. 2011;33:1433–43. CrossRef
- Mullins CD, Rattinger GB, Kuznik A, Koren MJ. Cost-effectiveness of intensive atorvastatin treatment in high-risk patients compared with usual care in a postgeneric statin market: economic analysis of the Aggressive Lipid-lowering Initiation Abates New Cardiac Events (ALLIANCE) study. Clin Ther. 2008;30:2204–16. CrossRef
- Plans-Rubio P. The cost effectiveness of statin therapies in Spain in 2010, after the introduction of generics and reference prices. Am J Cardiovasc Drugs. 2010;10:369–82. CrossRef
- Soini EJ, Davies G, Martikainen JA, Hu HX, Tunceli K, Niskanen L. Population-based health-economic evaluation of the secondary prevention of coronary heart disease in Finland. Curr Med Res Opin. 2010;26:25–36. CrossRef
- Wagner M, Goetghebeur M, Merikle E, Pandya A, Chu P, Taylor DC. Cost-effectiveness of intensive lipid lowering therapy with 80 mg of atorvastatin, versus 10 mg of atorvastatin, for secondary prevention of cardiovascular disease in Canada. Can J Clin Pharmacol. 2009;16:e331–45.
- Kildemoes HW, Andersen M, Stovring H. The impact of ageing and changing utilization patterns on future cardiovascular drug expenditure: a pharmacoepidemiological projection approach. Pharmacoepidemiol Drug Saf. 2010;19:1276–86. CrossRef
- Bennie M, Godman B, Bishop I, Campbell S. Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland. Expert Rev Pharmacoecon Outcomes Res. 2012;12:125–30. CrossRef
- McGinn D, Godman B, Lonsdale J, Way R, Wettermark B, Haycox A. Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications. Expert Rev Pharmacoecon Outcomes Res. 2010;10:73–85. CrossRef
- Arickx F, Bormans V, Leveque F, Mortier M, Soete E, Vanhaeren E. Public tendering for off patent medicines in Belgium—the simvastatin case. Brussels: National Institute for Health and Disability Insurance; 2009.
- Puig-Junoy J. The impact of generic reference pricing interventions in the statin market. Health Policy. 2007;84:14–29. CrossRef
- Stargardt T. The impact of reference pricing on switching behaviour and healthcare utilisation: the case of statins in Germany. Eur J Health Econ. 2010;11:267–77. CrossRef
- Godman B, Shrank W, Andersen M, Berg C, Bishop I, Burkhardt T, et al. Comparing policies to enhance prescribing efficiency in Europe through increasing generic utilization: changes seen and global implications. Expert Rev Pharmacoecon Outcomes Res. 2010;10:707–22. CrossRef
- Generic Atorvastatin, the Belgian Statin Market and the Cost-Effectiveness of Statin Therapy
Cardiovascular Drugs and Therapy
Volume 27, Issue 1 , pp 49-60
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Research Centre for Pharmaceutical Care and Pharmaco-economics, KU Leuven, Onderwijs en Navorsing 2 bus 521, Herestraat 49, 3000, Leuven, Belgium
- 2. Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium