Cost-effectiveness of single agent, uptitration and switching statin treatment strategies for lipid lowering in Sweden

Abstract

Objectives:

To assess which alternative treatment strategies are optimum in terms of cost-effectiveness (EUR/patient treated to target, EUR/PTT) in lowering cholesterol in high-risk patients with elevated LDL-cholesterol (LDL-C) in Sweden.

Methods:

A probabilistic cost-effectiveness model was developed to estimate the mean expected costs and proportion of patients reaching goal attainment (defined as LDL-C ≤2.5 mmol/L [96.5 mg/dL]) at some point in time within a 52-week period following the initiation of statin therapy. Eight different statin treatment strategies were evaluated. Key data sources used in the modeling were the scientific literature, hospital tariffs and medicine price databases.

Results:

Depending on baseline LDL-C and the willingness-to-pay per additional PTT, the cost-effective alternative is always found among four out of the eight assessed treatment strategies (i.e. Simva10 → Simva20 → Simva40, Rosu10, Simva20 → Rosu10 → Rosu20 → Rosu40, or Simva20 → Simva40 → Rosu20 → Rosu40). An important finding was that when LDL-C level exceed 4.0 mmol/L (154mg/dL) and when willingness to pay is less than 500 EUR per additional PTT, the optimal treatment strategy would be to initiate cholesterol-lowering treatment directly with rosuvastatin 10 mg.

Conclusions:

The results of this study indicate that the optimal approach to initiate lipid-lowering therapy would be to treat patients with the lower baseline LDL-C levels with the least costly treatment strategies, while initiating lipid-lowering treatment with a high-potency statin (rosuvastatin) in patients with moderately high or high baseline LDL-C levels. This recommendation can be assumed to be relevant particularly when the fact that after treatment initiation the majority of Swedish patients will not have any changes in their lipid-lowering medication or dose is taken into account. Finally, since only the short-term results are presented here, it would be valuable to conduct further studies of the long-term cost-effectiveness of different statin treatment strategies that focus on treatment persistence and LDL-C goal attainment in real practice.

Key words::

• Coronary heart disease
• Cost-effectiveness
• Statin
• Treatment target

Transparency

Declaration of funding

This study was funded and supported by AstraZeneca AB, Södertälje, Sweden.

Declaration of financial/other relationships

J.M. and E.S. have disclosed that they are consultants, employees and shareholders of ESiOR, which was commissioned by AstraZeneca to perform this study. ESiOR also carries out commissioned studies and health-economic analysis for several other pharmaceutical companies, food industry companies and hospitals. T.P. has disclosed that he is employed by AstraZeneca.

All editorial decisions were made on the basis of scientific consideration by J.M. and E.S. with no important editorial role for the sponsor.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors thank Martin Henriksson, PhD for comments that helped us improve the manuscript and David Laaksonen, MD, PhD for language revision.

Selected results of this study were presented as a poster at the ISPOR 11th Annual European Congress, Athens, Greece, 9th September 2008.