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 £20 000/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 £11 103/QALY. The ICER remained below the £20 000 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.

Key words::

• Cost effectiveness
• Familial hypercholesterolaemia
• Markov modelling
• QALYs
• Statins

Transparency

Declaration of funding

The National Collaborating Centre for Primary Care was commissioned and funded by the National Institute for Health and Clinical Excellence (NICE) to develop the Guideline for the identification and management of adults and children with FH. This article reports work that was undertaken at the request of the NICE Guideline Development Group. The full guideline can be accessed at http://www.nice.org.uk/Guidance/CG71. Any opinions expressed in this article are those of the authors and not intended to represent those of any affiliated organisations.

Declaration of financial/other relationships

H.A.W.N. has disclosed serving as consultant to pharmaceutical companies marketing lipid-lowering drugs including Pfizer, Schering-Plough, Merck Sharp & Dohme and Solvay Healthcare and has received travel expenses, payment for speaking at meetings and funding for research from some of these companies

R.M. has disclosed receiving lecture honoraria and travel grants from AstraZeneca, Fournier-Solvay, GlaxoSmithKline, Merck Sharp & Dohme, Pfizer and Sanofi-Aventis, with none during the last 3 years; R.M. was Chairman of the NICE Guideline Development Group for the Guideline for identification and management of adults and children with familial hypercholesterolaemia. L.N., N.C., K.D., M.T., and S.E.H. have disclosed that they have no relevant financial relationships.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewers for this article have disclosed that they have no relevant financial relationships.

Acknowledgements

H.A.W.N. and S.E.H. would like to acknowledge grants RG3008 and PG2005/014 from the British Heart Foundation. R.M. acknowledges funding support from the Commonwealth Fund.