How cost-effective is the treatment of dyslipidemia in patients with diabetes but without cardiovascular disease?
OBJECTIVE
Epidemiological studies have shown that the risk of myocardial infarction (MI) in diabetic patients without cardiovascular disease (CVD) is comparable to the risk of MI in patients with CVD. We used a validated Markov model to compare the long-term costs and benefits of treating dyslipidemia in diabetic patients without CVD versus treating CVD patients without diabetes in the U.S. The generalizability and robustness of these results were also compared across six other countries (Canada, France, Germany, Italy, Spain, and the U.K.).


METHODS
With use of the Cardiovascular Disease Life Expectancy Model, cost effectiveness simulations of simvastatin treatment were performed for men and women who were 40-70 years of age and had dyslipidemia. We forecast the long-term risk reduction in CVD events after treatment. On the basis of the Scandinavian Simvastatin Survival Study results, we assumed a 35% reduction in LDL cholesterol and an 8% rise in HDL cholesterol.


RESULTS
In the U.S., treatment with simvastatin for CVD patients without diabetes was cost-effective, with estimates ranging from $8,799 to $21,628 per year of life saved (YOLS). Among diabetic individuals without CVD, lipid therapy also appeared to be cost-effective, with estimates ranging from $5,063 to $23,792 per YOLS. In the other countries studied, the cost effectiveness of treating diabetes in the absence of CVD was comparable to the cost effectiveness of treating CVD in the absence of diabetes.


CONCLUSIONS
Among diabetic men and women who do not have CVD, lipid therapy is likely to be as effective and cost-effective as treating nondiabetic individuals with CVD.
Grover
S A
SA
Centre for the Analysis of Cost-Effective Care and the Division of General Internal Medicine, Montreal General Hospital, Quebec, Canada. mdev@musica.mcgill.ca
Coupal
L
L
Zowall
H
H
Alexander
C M
CM
Weiss
T W
TW
Gomes
D R
DR
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D012307:Risk Factors; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use
D019821:Simvastatin