title: Cost-effectiveness of gemfibrozil for coronary heart disease patients with low levels of high-density lipoprotein cholesterol: the Department of Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial.
abstract: BACKGROUND
  Although numerous clinical trials and economic analyses have established the efficacy and cost-effectiveness of lowering cholesterol for the prevention of coronary heart disease, there are few data on the role of raising high-density lipoprotein cholesterol (HDL-C) levels and lowering triglyceride levels. The US Department of Veterans Affairs (VA) Cooperative Studies Program HDL-C Intervention Trial (VA-HIT) was a multicenter, randomized trial of gemfibrozil, an agent that raised HDL-C levels and lowered triglyceride levels, yet had no effect on low-density lipoprotein cholesterol (LDL-C) levels. The study showed that gemfibrozil therapy significantly reduced major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with coronary heart disease, low HDL-C levels, and low LDL-C levels.
  
  
  OBJECTIVE
  To report the results of a cost-effectiveness study based on the results of the VA-HIT.
  
  
  METHODS
  The cost per year of life gained with gemfibrozil therapy was calculated. Hazard functions were estimated, and the resulting probabilities were used in a Markov model simulation to estimate the effect of gemfibrozil on life expectancy and costs over a simulated lifetime. Sensitivity analyses were used to account for uncertainty.
  
  
  RESULTS
  Using the prices of gemfibrozil that were negotiated by the VA, gemfibrozil was cost saving. Using drug prices found outside the VA, a quality-adjusted life-year saved by gemfibrozil therapy cost between $6300 and $17 100.
  
  
  CONCLUSIONS
  Gemfibrozil reduces major cardiovascular events in male coronary heart disease patients with low levels of HDL-C and low levels of LDL-C and would result in cost saving at annual drug costs of $100 or less in 1998 dollars. Even at the higher drug prices represented by the average wholesale price in the United States, the cost of a life-year saved is well below the threshold that would be deemed cost-effective. To our knowledge, this is the first economic analysis based on clinical trial data to assess the cost-effectiveness of raising HDL-C levels and lowering triglyceride levels in a setting in which LDL-C levels were not lowered.
authors.affiliation: Division of Health Services Research and Policy, University of Minnesota, 420 Delaware St SE, Mail Route 729, Minneapolis, MN 55455-0392, USA. nyman001@tc.umn.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Nyman
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Martinson
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.forename: Sean
authors.initials: S
authors.lastname: Nugent
authors.forename: Dorothea
authors.initials: D
authors.lastname: Collins
authors.forename: Janet
authors.initials: J
authors.lastname: Wittes
authors.forename: Carol L
authors.initials: CL
authors.lastname: Fye
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Sander J
authors.initials: SJ
authors.lastname: Robins
authors.forename: Hanna
authors.initials: H
authors.lastname: Bloomfield Rubins
mesh_terms: D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D015248:Gemfibrozil / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D014280:Triglycerides / Q000097:blood; D014481:United States
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D014280:Triglycerides; D015248:Gemfibrozil