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A Model to Assess the Cost Effectiveness of Statins in Achieving the UK National Service Framework Target Cholesterol Levels

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Abstract

Background: Coronary heart disease (CHD) is a public health priority in theUK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available.

Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets.

Design: Model-based economic evaluation.

Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DINLINK database.

Results:Methods: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastatin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs.

Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

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References

  1. British Heart Foundation. Available on URL: www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/mortality.html [Accessed Nov 2002]

  2. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Lancet 1999; 353: 1547–57

    Article  PubMed  CAS  Google Scholar 

  3. The Scandinavian Simvastatin Survival Study group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival study (4S). Lancet 1994; 344: 1383–9

    Google Scholar 

  4. British Heart Foundation. Statistics for coronary heart disemase [online]. Available on URL: www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/economiccosts.html [Accessed Nov 6 2002]

  5. Wood D, Durrington P, McInnes G, et al. Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998; 80 Suppl. 2: S1–29

    Google Scholar 

  6. Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992; 152: 1490–500

    Article  PubMed  CAS  Google Scholar 

  7. Davey-Smith G, Shipley MJ, Marmot MG, et al. Plasma cholesterol and mortality: the Whitehall Study. JAMA 1992; 267: 70–6

    Article  Google Scholar 

  8. Chen Z, Peto R, Collins T, et al. Serum cholesterol concentration and coronary heart disease in a population with low cholesterol concentrations. BMJ 1991; 303: 276–82

    Article  PubMed  CAS  Google Scholar 

  9. National Heart Forum. Coronary heart disease: estimating the impact of changes in risk factors. London: The Stationery Office. In press, 2002. Available on URL:www.dphpc.ox.ac.uk/bhfhprg/stats/2000/2002/appendix.html [Accessed Aug 4 2002]

    Google Scholar 

  10. National Service Framework for coronary heart disease, Mar 2000 [online]. Available on URL: www.doh.gov.uk/nsf/coronary.html [Accessed Aug 2002]

  11. Jones P, Kafonek S, Laurora I, et al. Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin and fluvastatin in patients with hypercholesterolemia (The CURVES study). Am J Cardiol 1998; 81: 582–7

    Article  PubMed  CAS  Google Scholar 

  12. Stein E, Schopen U, Catagay M. A pooled efficacy analysis of cerivastatin in the treatment of primary hyperlipidemia. Clin Drug Invest 1999; 18 (6): 433–44

    Article  CAS  Google Scholar 

  13. Shepherd J, Cobbe S, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7

    Article  PubMed  CAS  Google Scholar 

  14. Athyros VG, Papageorgiou AA, Mercouris BR, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study. Curr Med Res Opin 2002; 18 (4): 220–8

    Article  PubMed  Google Scholar 

  15. La Rosa JC, He J, Vupputuri S. Effects of statins on risk of coronary disease: a meta-analysis of randomised controlled trials. JAMA 1999; 282: 2340–6

    Article  Google Scholar 

  16. Jönsson B, Johanneson M, Kjekshus J, et al. Cost-effectiveness of cholesterol-lowering: results from the simvastatin survival study. Eur Heart J 1996; 17: 1001–7

    Article  PubMed  Google Scholar 

  17. Caro J, Klittich W, McGuire A, et al. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997; 315: 1577–82

    Article  PubMed  CAS  Google Scholar 

  18. Pickin DM, McCabe CJ, Ramsay LE, et al. Cost effectiveness of HMG-CoA reductase inhibitor (statin) treatment related to risk of coronary heart disease and cost of drug treatment. Heart 1999; 82: 325–32

    PubMed  CAS  Google Scholar 

  19. Effective Health Care: cholesterol and coronary heart disease: screening and treatment. Bulletin on effectiveness of health service interventions for decision makers. York: NHS Centre for Reviews and Dissemination, University of York, 1998: 4 (1)

  20. Maclaine G, Patel H. A cost-effectiveness model of alternative statins to achieve target LDL-cholesterol levels. Int J Clin Pract 2001; 55 (4): 243–9

    PubMed  CAS  Google Scholar 

  21. Neil H, Fowler G, Patel H, et al. An assessment of the efficacy of atorvastatin in achieving LDL cholesterol target levels in patients with coronary heart disease: a general practice study. Int J Clin Pract 1999; 53 (6): 422–6

    PubMed  CAS  Google Scholar 

  22. DIN-LINK data. Report 1, lipid lowering MAT, Feb 2002. Compufile Ltd, May 2002

  23. Ose L, Kastelein J, Scott R, et al. Efficacy and six-month safety of simvastatin 80 mg/day: results from the Worldwide Simvastatin Expanded Dose Program (WSEDP). Nutr Metab Cardiovasc Dis 1998; 8: 135–43

    CAS  Google Scholar 

  24. Ballantyne CM, McKenney J, Trippe BS. Efficacy and safety of an extended-release formulation of fluvastatin for once-daily treatment of primary hypercholesterolemia. Am J Cardiol 2000; 86: 759–63

    Article  PubMed  CAS  Google Scholar 

  25. Gould AL, Rossouw JE, Santanello NC, et al. Cholesterol reduction yields clinical benefit: impact of statin trials. Circulation 1998; 97: 946–52

    Article  PubMed  CAS  Google Scholar 

  26. Hilleman DE, Phillips JO, Mohiuddin SM, et al. A population-based treat-to-target pharmacoeconomic analysis of HMGCoA reductase inhibitors in hypercholesterolemia. Clin Ther 1999; 21 (3): 536–62

    Article  PubMed  CAS  Google Scholar 

  27. Hilleman DE, Heineman SM, Foral PA. Pharmacoeconomic assessment of HMG-CoA reductase inhibitor therapy: an analysis based on the CURVES study. Pharmacotherapy 2000; 20 (7): 819–22

    Article  PubMed  CAS  Google Scholar 

  28. Hilleman D, Wurdeman RL, Lenz TL. Therapeutic change of HMG-CoA reductase inhibitors in patients with coronary artery disease. Pharmacotherapy 2001; 21: 410–5

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank David Grant and Adam Lloyd from Fourth Hurdle for their contribution. Funding was provided by Pfizer Ltd, UK.

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Correspondence to Koo Wilson.

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Wilson, K., Marriott, J., Fuller, S. et al. A Model to Assess the Cost Effectiveness of Statins in Achieving the UK National Service Framework Target Cholesterol Levels. Pharmacoeconomics 21 (Suppl 1), 1–11 (2003). https://doi.org/10.2165/00019053-200321001-00001

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