Budget impact of rosuvastatin initiation in high-risk hyperlipidemic patients from a US managed care perspective

Figures & data

Figure 1. Model structure.

Table 1. Patient population.

Risk group	Number of patients31,32	Average LDL-C level14	Goal LDL-C level19
Low	240	189 mg/dL	160 mg/dL
Moderate	240	189 mg/dL	130 mg/dL
High	520	189 mg/dL	100 mg/dL

LDL-C, low-density lipoprotein cholesterol.

Table 2. Starting doses.

Statin	5 mg	10 mg	20 mg	40 mg	80 mg
Rosuvastatin20	20%	54%	20%	6%	–
Simvastatin32	1%	11%	49%	35%	4%
Atorvastatin20	–	33%	36%	22%	9%

Table 3. Percent reduction in LDL-C levels14.

Statin	5 mg	10 mg	20 mg	40 mg	80 mg
Rosuvastatin	42%*	46%	52%	55%	–
Simvastatin	22%*	28%	35%	39%	46%
Atorvastatin	–	37%	43%	48%	51%

LDL-C, low-density lipoprotein cholesterol.

*The efficacy of these doses was extrapolated using data for rosuvastatin and simvastatin doses investigated in the STELLAR trial14.

Table 4. Treatment decision in patients failing to reach goal20.

Statin	5 mg	10 mg	20 mg	40 mg	80 mg
Rosuvastatin^a
Titrate	13%	11%	12%	–	–
No change	87%	89%	88%	100%	–
Simvastatin
Titrate	12%^b	11%^b	8%^b	6%^b	–
Switch	31%^c	30%^c	30%^c	29%^c	33%^c
No change	57%^d	59%^d	62%^d	65%^d	67%^d
Atorvastatin
Titrate	–	8%^b	8%^b	8%^b	–
Switch	–	30%^c	30%^c	30%^c	31%^c
No change	–	62%^d	62%^d	62%^d	69%^d

^aIt was assumed that patients receiving rosuvastatin would not switch to a different statin.

^bThese parameters were all increased and decreased by 10% relative to the base-case value in the sensitivity analysis labeled as [10] in Figure 4.

^cThese parameters were all increased and decreased by 10% relative to the base-case value in the sensitivity analysis labeled as [7] in Figure 4.

^dThese parameters were all increased and decreased by 10% relative to the base-case value in the sensitivity analysis labeled as [6] in Figure 4.

Table 5. Statin dose received by switching patients20.

Statin	5 mg	10 mg	20 mg	40 mg	80 mg
Simvastatin
Rosuvastatin 5 mg	39%	26%	17%	13%	11%
Rosuvastatin 10 mg	9%	32%	37%	52%	65%
Atorvastatin 10 mg	43%	32%	24%	11%	9%
Atorvastatin 20 mg	9%	10%	22%	24%	15%
Atorvastatin
Rosuvastatin 5 mg	–	40%	28%	18%	19%
Rosuvastatin 10 mg	–	60%	72%	82%	81%

Table 6. WAC for statins.

Statin	5 mg	10 mg	20 mg	40 mg	80 mg
Rosuvastatin34	$5.39	$5.39	$5.39	$5.39	–
Simvastatin20	$0.06*	$0.06	$0.13	$0.11	$0.13
Atorvastatin20	–	$0.37	$0.53	$0.53	$0.53

WAC, wholesale acquisition costs.

*The WAC of simvastatin 5 mg was not reported, and was therefore assumed to be the same as that of simvastatin 10 mg.

Table 7. Rebates, dispensing fees, and copayments20,34.

Statin	Rebate	Dispensing fee	Copayment
Rosuvastatin	41%	$2.00	$50
Simvastatin	0%	$2.50	$5
Atorvastatin	0%	$2.50	$5

WAC, wholesale acquisition costs.

Table 8. Proportional distribution of CV events and associated costs38,39.

Event	Proportion of events	Cost per event
Non-fatal myocardial infarction	25%	$13,255
Fatal myocardial infarction	10%	$16,951
Non-fatal stroke	53%	$19,096
Fatal stroke	12%	$19,652

CV, cardiovascular.

Figure 2. Patients reaching their LDL-C goal, by risk group.

Figure 3. Net spending over 3 years, by risk group.

Figure 4. Sensitivity analyses. One-way sensitivity analyses were performed by varying the following model parameters by ±10% relative to the base-case value: [1] Rebate of rosuvastatin; [2] Average population LDL-C level; [3] Tier 3 copayment; [4] LDL-C goal of patients with high CV risk; [5] Proportion of patients with high CV risk; [6] Proportion of atorvastatin and simvastatin patients continuing to receive the same dose; [7] Proportion of atorvastatin and simvastatin patients switching to a different statin; [8] Tier 1 copayment; [9] Dispensing fee of rosuvastatin; [10] Proportion of atorvastatin and simvastatin patients titrating to a higher dose. Parameters directly affecting the cost of rosuvastatin ([1], [3]) have the greatest impact on the budget impact, as do the average LDL-C level of the population ([2]) and the LDL-C goal of patients with high CV risk ([4]); titration and switching decisions ([6], [7], [10]) for patients failing to reach goal have less of an impact on the model results.

Figure 5. Scenario analyses. Event costs were included based on the average cost per CV event38,40 and the number of patients experiencing CV events among those reaching and failing to reach their LDL-C goal6,38,39. Real-life efficacy was estimated by decreasing the efficacy of all statin doses by 21%33.

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