A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention.
BACKGROUND
The Lescol Intervention Prevention Study (LIPS) was a multinational randomized controlled trial that showed a 47% reduction in the relative risk of cardiac death and a 22% reduction in major adverse cardiac events (MACEs) from the routine use of fluvastatin, compared with controls, in patients undergoing percutaneous coronary intervention (PCI, defined as angioplasty with or without stents). In this study, MACEs included cardiac death, nonfatal myocardial infarction, and subsequent PCI and coronary artery bypass graft. Diabetes was the greatest risk factor for MACEs.


OBJECTIVE
This study estimated the cost-effectiveness of fluvastatin when used for secondary prevention of MACEs after PCI in people with diabetes.


METHODS
A post hoc subgroup analysis of patients with diabetes from the LIPS was used to estimate the effectiveness of fluvastatin in reducing myocardial infarction, revascularization, and cardiac death. A probabilistic Markov model was developed using United Kingdom resource and cost data to estimate the additional costs and quality-adjusted life-years (QALYs) gained over 10 years from the perspective of the British National Health Service. The model contained 6 health states, and the transition probabilities were derived from the LIPS data. Crossover from fluvastatin to other lipid-lowering drugs, withdrawal from fluvastatin, and the use of lipid-lowering drugs in the control group were included.


RESULTS
In the subgroup of 202 patients with diabetes in the LIPS trial, 18 (15.0%) of 120 fluastatin patients and 21 (25.6%) of 82 control participants were insulin dependent (P = NS). Compared with the control group, patients treated with fluvastatin can expect to gain an additional mean (SD) of 0.196 (0.139) QALY per patient over 10 years (P < 0.001) and will cost the health service an additional mean (SD) of 10 pounds ( 448 pounds) (P = NS) (mean [SD] US $16 [$689]). The additional cost per QALY gained was 51 pounds (US $78). The key determinants of cost-effectiveness included the probabilities of repeat interventions, cardiac death, the cost of fluvastatin, and the time horizon used for the evaluation.


CONCLUSIONS
Fluvastatin was an economically efficient treatment to prevent MACEs in these patients with diabetes undergoing PCI.
Scuffham
Paul A
PA
School of Population Health, University of Queensland Medical School, Herston, Brisbane, Australia. p.scuffham@uq.edu.au
Chaplin
Stephen
S
D015906:Angioplasty, Balloon, Coronary; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D005229:Fatty Acids, Monounsaturated / Q000191:economics* / Q000627:therapeutic use; D000077340:Fluvastatin; D006331:Heart Diseases / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D018803:Models, Economic; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D006113:United Kingdom
D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin