The cost of reaching National Cholesterol Education Program (NCEP) goals in hypercholesterolaemic patients. A comparison of atorvastatin, simvastatin, lovastatin and fluvastatin.
OBJECTIVE
Recognising the importance of treating hyperlipidaemia, the National Cholesterol Education Program (NCEP) has established widely accepted treatment goals for low density lipoprotein cholesterol (LDL-C). Medications used most commonly to achieve these LDL-C goals are HMG-CoA reductase inhibitors. The relative resource utilisation and cost associated with the use of reductase inhibitors of different LDL-C lowering efficacy are unknown, but are major health and economic concerns. The objective of this study was to determine the mean total cost of care to reach NCEP goals with various reductase inhibitors.


METHODS
In a randomised, 54-week, 30-centre controlled trial we compared resources used and costs associated with treating patients to achieve NCEP goals using 4 reductase inhibitors: atorvastatin, simvastatin, lovastatin and fluvastatin.


METHODS
The trial studied 662 patients; 318 had known atherosclerotic disease.


METHODS
Reductase inhibitor therapy was initiated at recommended starting doses and increased according to NCEP guidelines and package insert information. For patients who did not reach the goal at the highest recommended dose of each reductase inhibitor, the resin colestipol was added.


RESULTS
Patients treated with atorvastatin, compared-with other reductase inhibitors, were more likely to reach NCEP goals during treatment (p < 0.05), required fewer office visits (p < 0.001) and less adjuvant colestipol therapy (p = 0.001). Consequently, the mean total cost of care (1996 values) to reach NCEP goals was lower with atorvastatin [$US1064; 95% confidence interval (CI): $US953 to $US1176] compared with simvastatin ($US1471, 95% CI: $US1304 to $US1648), lovastatin ($US1972; 95% CI: $US1758 to $US2186) and fluvastatin ($US1542; 95% CI: $US1384 to $US1710). Results were similar for patients with or without known atherosclerotic disease.


CONCLUSIONS
In patients requiring drug therapy for hypercholesterolaemia, NCEP LDL-C goals are achieved significantly more often using fewer resources with atorvastatin compared with simvastatin, lovastatin or fluvastatin.
Koren
M J
MJ
Jacksonville Center for Clinical Research, Florida, USA.
Smith
D G
DG
Hunninghake
D B
DB
Davidson
M H
MH
McKenney
J M
JM
Weiss
S R
SR
Schrott
H G
HG
Henley
R W
RW
Tresh
P
P
McLain
R W
RW
Bakker-Arkema
R G
RG
Black
D M
DM
D000368:Aged; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D000069059:Atorvastatin; D003362:Cost-Benefit Analysis; D005229:Fatty Acids, Monounsaturated / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D006291:Health Policy / Q000191:economics*; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics*; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D008148:Lovastatin / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D019821:Simvastatin / Q000191:economics* / Q000627:therapeutic use; D014481:United States
D000924:Anticholesteremic Agents; D005229:Fatty Acids, Monounsaturated; D006538:Heptanoic Acids; D007211:Indoles; D011758:Pyrroles; D000077340:Fluvastatin; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin