Are intensive lipid-lowering regimens an optimal economic strategy in patients with ACS? An acute and chronic perspective

Abstract

A literature review was conducted to identify studies exploring the cost–effectiveness of intensive lipid-lowering regimens compared with a generic low-dose statin for individuals with acute coronary syndrome. Three papers matched the inclusion criteria. All used a Markov model to represent the long-term clinical pathway; two were set in the UK and one was in the USA. While there were substantial differences in the effectiveness data, the definitions of the health states and the numbers of events predicted, all authors found that the intensive regimen was a cost-effective alternative compared with a generic lower dose statin. If the cost of atorvastatin reduces from GBP£ 368 to £90 per annum when the patent expires in 2011, atorvastatin 80 mg/day would be the most optimal treatment for this patient group. Simvastatin 80 mg/day should not be considered an alternative owing to an adverse safety profile and limited additional benefits.

Keywords::

• acute coronary syndrome
• atorvastatin
• cost–effectiveness
• economic evaluation
• lipid-lowering
• rosuvastatin
• simvastatin

Financial & competing interest disclosure

This work is an unfunded piece of research. Anthony S Wierzbicki and Tim M Reynolds have served as consultants to and received travel expenses and payment for speaking at meetings from pharmaceutical companies marketing lipid-lowering drugs (AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Merck-Schering Plough, Novartis, Pfizer). Anthony S Wierzbicki has served on advisory boards for pharmaceutical companies marketing lipid-lowering drugs (AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Merck-Schering Plough, Novartis, Pfizer) and was a clinical adviser to the National Institute for Health and Clinical Excellence on the technology appraisal for ezetimibe. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.