PharmacoEconomics

, Volume 14, Issue 1, pp 59–70

The Cost of Reaching National Cholesterol Education Program (NCEP) Goals in Hypercholesterolaemic Patients

A Comparison of Atorvastatin, Simvastatin, Lovastatin and Fluvastatin
  • Michael J. Koren
  • Dean G. Smith
  • Donald B. Hunninghake
  • Michael H. Davidson
  • James M. McKenney
  • Stuart R. Weiss
  • Robert W. HenleyJr
  • Perry Tresh
  • Richard W. McLain
  • Rebecca G. Bakker-Arkema
  • Donald M. Black
Original Research Article Costs and NCEP Goals

Abstract

Objective: Recognising the importance of treating hyperlipidaemia, the National Cholesterol Education Program (NCEP) has established widely accepted treatment goals for low density lipoprotein cholesterol (LDL-C). Medications used most commonly to achieve these LDL-C goals are HMG-CoA reductase inhibitors. The relative resource utilisation and cost associated with the use of reductase inhibitors of different LDL-C lowering efficacy are unknown, but are major health and economic concerns. The objective of this study was to determine the mean total cost of care to reach NCEP goals with various reductase inhibitors.

Design: In a randomised, 54-week, 30-centre controlled trial we compared resources used and costs associated with treating patients to achieve NCEP goals using 4 reductase inhibitors: atorvastatin, simvastatin, lovastatin and fluvastatin.

Patients and Participants: The trial studied 662 patients; 318 had known atherosclerotic disease.

Interventions: Reductase inhibitor therapy was initiated at recommended starting doses and increased according to NCEP guidelines and package insert information. For patients who did not reach the goal at the highest recommended dose of each reductase inhibitor, the resin colestipol was added.

Main outcome measures and results: Patients treated with atorvastatin, compared with other reductase inhibitors, were more likely to reach NCEP goals during treatment (p < 0.05), required fewer office visits (p < 0.001) and less adjuvant colestipol therapy (p = 0.001). Consequently, the mean total cost of care (1996 values) to reach NCEP goals was lower with atorvastatin [$US1064; 95% confidence interval (CI): $US953 to $US1176] compared with simvastatin ($US1471; 95% CI: $US1304 to $US1648), lovastatin ($US1972; 95% CI: $US1758 to $US2186) and fluvastatin ($US1542; 95% CI: $US1384 to $US1710). Results were similar for patients with or without known atherosclerotic disease.

Conclusions: In patients requiring drug therapy for hypercholesterolaemia, NCEP LDL-C goals are achieved significantly more often using fewer resources with atorvastatin compared with simvastatin, lovastatin or fluvastatin.

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Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Michael J. Koren
    • 1
  • Dean G. Smith
    • 2
  • Donald B. Hunninghake
    • 3
  • Michael H. Davidson
    • 4
  • James M. McKenney
    • 5
  • Stuart R. Weiss
    • 6
  • Robert W. HenleyJr
    • 8
  • Perry Tresh
    • 9
  • Richard W. McLain
    • 9
  • Rebecca G. Bakker-Arkema
    • 9
  • Donald M. Black
    • 9
  1. 1.Jacksonville Center for Clinical ResearchJacksonvilleUSA
  2. 2.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  3. 3.Departments of Medicine and PharmacologyUniversity of MinnesotaMinneapolisUSA
  4. 4.Chicago Center for Clinical ResearchChicagoUSA
  5. 5.National Clinical ResearchRichmondUSA
  6. 6.The San Diego Endocrine & Medical Clinic, Inc.San DiegoUSA
  7. 7.Departments of Preventive Medicine and Internal MedicineUniversity of IowaIowa CityUSA
  8. 8.Cardiovascular Associates of VirginiaRichmondUSA
  9. 9.Parke Davis Pharmaceutical ResearchDivision of Warner-Lambert CompanyAnn ArborUSA

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