Cost-effectiveness of fluvastatin following successful first percutaneous coronary intervention.
BACKGROUND
In the LIPS (Lescol Intervention Prevention Study), fluvastatin 80 mg/day reduced the risk of major adverse cardiac events (MACE) by 22% versus placebo (p = 0.01) following successful first percutaneous coronary intervention (PCI) in patients with stable or unstable angina or silent ischemia. The cost-effectiveness of such therapy is unknown.


OBJECTIVE
To evaluate the cost-effectiveness of fluvastatin following successful first PCI from a US healthcare system perspective.


METHODS
We used a Markov model to estimate expected outcomes and costs of 2 alternative treatment strategies following successful first PCI in patients with stable or unstable angina or silent ischemia: (1) diet/lifestyle counseling plus immediate fluvastatin 80 mg/day; and (2) diet/lifestyle counseling only, with initiation of fluvastatin 80 mg/day following occurrence of future nonfatal MACE. The model was estimated with data from LIPS and other published sources. Cost-effectiveness was calculated as the ratio of the difference in expected medical-care costs to the expected difference in life-years (LYs) and quality-adjusted life-years (QALYs) alternatively.


RESULTS
Treatment with fluvastatin following successful first PCI was found to increase life expectancy by 0.78 years (QALYs 0.68). Cost-effectiveness of fluvastatin following successful first PCI is 13 505 dollars per LY (15 454 dollar per QALY) saved. Ratios are lower for patients with diabetes (9396 dollar per LY; 10 718 dollar per QALY) and those with multivessel disease (9662 dollar per LY; 11 076 dollar per QALY). Findings were robust with respect to changes in key model parameters and assumptions.


CONCLUSIONS
Fluvastatin therapy following PCI is cost-effective compared with other generally accepted medical interventions.
Delea
Thomas E
TE
Policy Analysis Inc. (PAI), Brookline, MA 02245-7629, USA. tdelea@pai2.com
Jacobson
Terry A
TA
Serruys
Patrick W J C
PW
Edelsberg
John S
JS
Oster
Gerry
G
D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000191:economics; D017225:Atherectomy, Coronary / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D005229:Fatty Acids, Monounsaturated / Q000191:economics* / Q000627:therapeutic use*; D000077340:Fluvastatin; D006801:Humans; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use*; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D040242:Risk Reduction Behavior
D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D000077340:Fluvastatin