The cost-effectiveness of fluvastatin in Hungary following successful percutaneous coronary intervention.
BACKGROUND
The Lescol Intervention Prevention Study (LIPS) showed substantial gains in health outcomes from statins following PCI. That study was a randomized double-blind placebo-controlled trial undertaken in 77 centres, predominantly in Europe, of patients with moderate hypercholesterolemia who had undergone their first PCI. The evidence on cost-effectiveness has been established for the UK, USA and the Netherlands, but due to different health system cost structures, the results may not be applicable to other European countries. The aim of this study was to estimate the cost-effectiveness of fluvastatin used following first PCI in Hungary.


METHODS
A deterministic Markov model was used to estimate the incremental costs per quality-adjusted life year gained, with cost data drawn from the Hungarian National Health Insurance Fund. Effectiveness data on fluvastatin was derived directly from LIPS and utility weights from previous studies on heart disease. Sensitivity analyses were conducted around key parameters and analyses were conducted for subgroups identified in LIPS.


RESULTS
Treatment with fluvastatin cost an additional 1,704 euro and resulted in an additional 0.107 QALYs per patient discounted over 10-years compared with controls. The incremental cost per quality-adjusted life year gained was 15,910 euro. The key determinants of cost-effectiveness were the effectiveness of fluvastatin, utility weights, cost of fluvastatin, and the time horizon evaluated. Fluvastatin was substantially more cost-effective in patients with diabetes, renal disease, multi-vessel disease or LDL-cholesterol >3.4 mmol/l.


CONCLUSIONS
Fluvastatin is an economically efficient pharmaceutical for reducing heart disease in Hungary and other European countries in patients following PCI.
Scuffham
Paul A
PA
Griffith University, Brisbane, Australia. P.Scuffham@griffith.edu.au
Kósa
József
J
D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D003327:Coronary Disease / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005229:Fatty Acids, Monounsaturated / Q000191:economics* / Q000627:therapeutic use; D000077340:Fluvastatin; D006801:Humans; D006814:Hungary; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009203:Myocardial Infarction / Q000517:prevention & control; D016019:Survival Analysis
D000924:Anticholesteremic Agents; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin