Cost-effectiveness of statins in the prevention of coronary heart disease events in middle-aged Finnish men

ABSTRACT

Objective: This study evaluated the long-term cost-effectiveness of atorvastatin 20 mg, rosuvastatin 10 mg and simvastatin 40 mg in primary and secondary prevention of CHD in Finland.

Research design and methods: The effect of statin therapy on the incidence of CHD and the expected total costs of the disease were described using a Markov state transition model. Due to the limited amount of evidence concerning mortality and morbidity for rosuvastatin, the model was used to transmute the efficiency data of all statins (decrease in total cholesterol) into long-term endpoints (myocardial infarction, death) using risk functions of the FINRISK and 4S studies. The study followed a characterized cohort of 55-year-old Finnish men with an average 3.3–6.6 % baseline risk of dying from cardiovascular disease within a 10-year period.

Main outcome measures: Incremental cost-effectiveness ratios (ICERs) for atorvastatin and rosuvastatin, compared with simvastatin, measured as cost of life years gained (€/LYG) and cost of quality adjusted life years gained (€/QALY).

Results: The use of rosuvastatin increased the life expectancy by 0.27 years on average (LYG) compared with simvastatin, producing additional 0.08 quality-adjusted life-years (QALYs). Compared with simvastatin, the cost of one LYG with rosuvastatin was €10 834 and the cost of one QALY gained was €36 548 (discount rate 5 % per annum). Corresponding figures for atorvastatin were €31 286/LYG and €105 599/QALY.

Conclusions: If the decision makers’ willingness to pay for a QALY gained is around €40 000 there is a high probability ( > 50 % ) that rosuvastatin represents a cost-effective form of therapy in the prevention of CHD in middle-aged men with an average 3.3–6.6 % risk of dying within 10 years from cardiovascular disease. However, the true clinical impact of these results needs confirmation from on-going clinical trials, as the role of rosuvastatin in reducing clinical events is pending, but for simvastatin and atorvastatin established.

Key words: :

• Atorvastatin
• Coronary heart disease
• Incremental cost-effectiveness
• Simvastatin

Acknowledgments

Declaration of interest: PP and JM were partly funded by an unrestricted research grant from AstraZeneca Oy, Finland. However, all authorship decisions were made on the basis of scientific consideration with no editorial role for the sponsor. Medical writing assistance was provided by Lionbridge Oy, Finland, and funded by AstraZeneca Oy, Finland.

At the time of the study, ES was employed in the University of Kuopio, Center for Pharmaceutical Policy and Economics (CEPPE) and he has not received any financial support related to this study. TH has no potential or real conflicts of interest relevant to this study. LN has received speaker fees and has participated in clinical trials sponsored by Astra-Zeneca.

PP and JM had joint responsibility for writing this manuscript and share the primary authorship of this paper. ES contributed to the quality of life data analysis and revised the manuscript. TH and LN participated in writing the manuscript.