title: Cost-effectiveness of fluvastatin following successful first percutaneous coronary intervention.
abstract: 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.
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA 02245-7629, USA. tdelea@pai2.com
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
authors.forename: Patrick W J C
authors.initials: PW
authors.lastname: Serruys
authors.forename: John S
authors.initials: JS
authors.lastname: Edelsberg
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: 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
chemical_list: D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D000077340:Fluvastatin