Cost-effectiveness analysis of the use of a high-intensity statin compared to a low-intensity statin in the management of patients with familial hypercholesterolaemia.

Abstract

OBJECTIVES:

To estimate, using probabilistic decision-analytic modelling techniques, the cost effectiveness of treating familial hypercholesterolaemia (FH) patients with high-intensity statins compared to treatment with low-intensity statins. For the purpose of this economic analysis, and based on their known differences, statins were categorised as high intensity if they produce greater LDL-cholesterol reductions than simvastatin 40 mg (e.g., simvastatin 80 mg and appropriate doses of atorvastatin and rosuvastatin or combination of statins + ezetimibe).

METHODS:

A lifetime Markov model was developed to estimate the incremental cost per quality adjusted life year (QALY) of treating a hypothetical cohort of 1000 FH patients aged between 20 and 70 years. Baseline coronary heart disease risks reported in the NICE TA 94 on statins, and age-adjusted risk of cardiovascular disease reported in the FH population, were used to populate the model. A meta-analysis estimate of the reduction in cardiovascular events from using high-intensity compared with low-intensity statins was obtained from published trials. Results were interpreted using a cost-effectiveness threshold of pound20 000/QALY.

RESULTS:

Fewer cardiovascular events and deaths were predicted to occur in the group treated with higher-intensity statins, and the incremental cost-effectiveness ratio (ICER) was estimated at pound11 103/QALY. The ICER remained below the pound20 000 threshold for 20-39-year-olds and 40-59-year-olds, but rose above this threshold in individuals aged over 60 years. One-way sensitivity analysis showed that results were most sensitive to variation in treatment effect on mortality and the cost of high-intensity statins.

CONCLUSIONS:

Modelling demonstrates that high-intensity statins are cost-effective for the treatment of younger FH patients. If, as is likely, the relative price of high-intensity statins fall in the future as they come off patent, then their cost effectiveness will improve further.

• Authors: L Nherera, N W Calvert, K Demott, S E Humphries, H A W Neil, R Minhas, M Thorogood
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 26 Issue 3 Pg. 529-36 (Mar 2010) ISSN: 1473-4877 [Electronic] England
• PMID: 20014994 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anticholesteremic Agents
• Azetidines
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Ezetimibe

Topics

• Adult
• Age Factors
• Aged
• Anticholesteremic Agents (administration & dosage, economics)
• Azetidines (administration & dosage, economics)
• Cardiovascular Diseases (drug therapy, economics, etiology, mortality)
• Costs and Cost Analysis
• Drug Therapy, Combination (economics)
• Ezetimibe
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage, economics)
• Hyperlipoproteinemia Type II (complications, drug therapy, economics, mortality)
• Male
• Middle Aged
• Models, Theoretical
• Risk Factors