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Statins for Cardiovascular Prevention According to Different Strategies

A Cost Analysis

  • Original Research Article
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Abstract

Background

Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established.

Objective

To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines, over a 10-year period.

Methods

The overall 10-year costs, costs of one CHD death averted, and of 1 year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS), and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment.

Results

Using an inflation rate of medical costs of 3%, a single yearly consultation, a single total cholesterol measurement per year, and a generic statin, the overall 10-year costs of the ESC, IAS, and ATP-III strategies were 2.2, 3.4, and 4.1 billion Swiss francs (SwF [SwF1 = $US0.97]). In this scenario, the average cost for 1 year of life gained was SwF352, SwF421, and SwF485 thousand, respectively, and it was always higher in women than in men. In men, the average cost for 1 year of life without CHD was SwF30.7, SwF42.5, and SwF51.9 thousand for the ESC, IAS, and ATP-III strategies, respectively, and decreased with age. Statin drug costs represented between 45% and 68% of the overall preventive cost. Changing the cost of statins, inflation rates, or number of fatal and non-fatal cases of CHD averted showed ESC guidelines to be the most cost effective. Conclusion: The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.

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Table I
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Table III
Table IV

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Acknowledgments

The CoLaus study was supported by research grants from Glaxo-SmithKline, the Faculty of Biology and Medicine of Lausanne, Switzerland and the Fonds National Suisse de la Recherche (grant no: 33CSCO-122661). Dr Rodondi has received unrestricted grant funding from Pfizer for an investigator-initiated study to assess quality of care in Switzerland and speaker fees from Pfizer, AstraZeneca, and MSD. None of the other authors have any additional conflicts of interest to declare that relate to the content of this article. The authors express their gratitude to the participants in the Lausanne CoLaus study; to the investigators who have contributed to the recruitment of patients, and in particular Yolande Barreau, Anne-Lise Bastian, Binasa Ramic, Martine Moranville, Martine Baumer, Marcy Sagette, Jeanne Ecoffey, and Sylvie Mermoud for data collection. We thank Vincent Mooser from GlaxoSmithKline and Christophe Pinget for assistance in writing the manuscript.

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Authors and Affiliations

  1. Institute of Health Economics and Management (IEMS), University of Lausanne, Lausanne, Switzerland

    Marcia K. Ito

  2. Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Bugnon 17, 1005, Lausanne, Switzerland

    David Nanchen, Fred Paccaud &  Pedro Marques-Vidal

  3. Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland

    David Nanchen & Nicolas Rodondi

  4. Department of Medicine, Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Gérard Waeber & Peter Vollenweider

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  1. Marcia K. Ito
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  2. David Nanchen
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  7. Pedro Marques-Vidal
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Corresponding author

Correspondence to Pedro Marques-Vidal.

Appendix 1

Appendix 1

Formulas used

10-year cost of prevention for one subject

Pr ev = (A × 365.25 + B + C) × 10 × (1 + D)9

A = daily cost of statins (see Methods for further details)

B = yearly cost of biological assessments (see Methods for further details)

C = yearly cost of medical consultations (see Methods for further details)

D = yearly inflation of medical costs (set here at 3%).[27]

Overall cost of prevention for sex x

figure U1

Nix = number of subjects eligible and untreated in the Swiss population without cardiovascular disease for age group i and sex x (obtained from Nanchen et al.[11]).

It is assumed that the number of subjects who cease to take statins due to death or other reasons is negligible relative to SNix.

Cost to prevent one death from coronary heart disease for sex x

figure U2

Deathix = number of potential CHD deaths averted by statins in the Swiss population if there is full compliance with guidelines for age group i and sex x (obtained from Nanchen et al.[11]).

Five-year cost of a non-fatal myocardial infarction (MI) for sex x

5NF x − (E + F + G × (K − 1)) × (1 + D)4 + (12 × J × K) × H x

D = yearly inflation of medical costs (set here at 3%)[27]

E = cost of acute treatment of an MI[24]

F = first year (non-acute) cost of treating a patient with an MI[25]

G = subsequent yearly cost of treating a patient with an MI[25]

Hx = median monthly salary for sex x (set here at SwF6000 for men and SwF5000 for women)[26]

J = % work loss (set here at 20%)[28,29]

K = number of years (set here at the median of the 10-year period, i.e. 5).

The first part of the equation relates to medical expenses while the other part relates to productivity losses.

Five-year cost of a fatal MI for sex x

5F x = (E × L x) + (12 × K) × H x × (1 + M)K −1

E = cost of acute treatment of an MI[24]

K = number of years (set here at the median of the 10-year period, i.e. 5)

Lx = percentage of fatal myocardial infarctions of sex x who are hospitalized (set here at 27% for men and 40% for women)[32]

Hx = median monthly salary for sex x (set here at SwF6000 for men and SwF5000 for women)[26]

M = average yearly increase in salaries (set here at 2%).

The first part of the equation relates to medical expenses while the other part relates to productivity losses.

Average cost of year of life gained for a 5-year period for sex x (as in table III)

figure U3

Deathix = number of potential CHD deaths averted by statins in the Swiss population if there is full compliance with guidelines for age group i and sex x (obtained from Nanchen et al.[11]).

Average cost of year of life without CHD for a 5-year period for sex x (as in table IV)

figure U4

CHDix = potential MI averted if statin for all eligible adults of age i and sex x (obtained from Nanchen et al.[11]).

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Ito, M., Nanchen, D., Rodondi, N. et al. Statins for Cardiovascular Prevention According to Different Strategies. Am J Cardiovasc Drugs 11, 33–44 (2011). https://doi.org/10.2165/11586760-000000000-00000

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