A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels.
BACKGROUND
Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available.


OBJECTIVE
To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets.


METHODS
Model-based economic evaluation.


METHODS
An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database.


RESULTS
The estimated annual drug cost per 1000 patients treated with atorvastatin was pound 289000, with simvastatin pound 315000, with pravastatin pound 333000 and with fluvastatin pound 167000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastatin were pound 198 and pound 226 for atorvastatin, pound 443 and pound 567 for simvastatin and pound 1089 and pound 2298 for pravastatin, using 2002 drug costs.


CONCLUSIONS
As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.
Wilson
Koo
K
Pfizer Ltd, Walton Oaks, Tadworth, Surrey, UK. Koo.Wilson@pfizer.com
Marriott
John
J
Fuller
Stephen
S
Lacey
Loretto
L
Gillen
David
D
D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D005229:Fatty Acids, Monounsaturated / Q000191:economics / Q000627:therapeutic use; D000077340:Fluvastatin; D006538:Heptanoic Acids / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000191:economics*; D007211:Indoles / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
D005229:Fatty Acids, Monounsaturated; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D011758:Pyrroles; D000077340:Fluvastatin; D002784:Cholesterol; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin