A pharmacoeconomic evaluation of the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study in the United Kingdom.
OBJECTIVE
To determine the short-term healthcare costs associated with intensive lipid lowering with atorvastatin initiated within 24-96 hours of the occurrence of acute coronary syndrome (ACS) in patients in the UK.


METHODS
Patient-level clinical outcome data from the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial and standard cost data were used to compare the total expected 16-week cost per patient on atorvastatin 80 mg/day versus placebo. Clinical outcomes assessed included the following: death; cardiac arrest with resuscitation; nonfatal myocardial infarction; worsening angina pectoris with objective evidence of myocardial ischaemia requiring rehospitalisation; surgical or percutaneous coronary revascularisation; nonfatal stroke; hospitalisation for angina without objective evidence of myocardial ischaemia; and new or worsening congestive heart failure requiring rehospitalisation. All relevant direct medical costs from the perspective of the NHS were considered.


RESULTS
The total expected cost was pound 784.05 per patient in the placebo cohort and pound 851.59 per patient in the atorvastatin cohort, resulting in an incremental cost of pound 67.54 per patient in the atorvastatin group. The cost per event avoided was pound 1762.04. A third of the cost of atorvastatin treatment was offset within 16 weeks by the cost savings resulting from the reduction in the number of events in the atorvastatin cohort compared with the placebo cohort.


CONCLUSIONS
The clinical benefits of short-term intensive atorvastatin treatment administered after ACS is attainable through a marginal increase in 'upfront' costs.
Buller
Nigel
N
Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Gillen
David
D
Casciano
Roman
R
Doyle
John
J
Wilson
Koo
K
D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use*; D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D023381:Endpoint Determination; D017048:Health Care Costs; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome; D006113:United Kingdom
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D002784:Cholesterol; D000069059:Atorvastatin