title: Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS).
abstract: OBJECTIVE
  We estimated the cost-effectiveness of atorvastatin treatment in the primary prevention of cardiovascular disease in patients with type 2 diabetes using data from the Collaborative Atorvastatin Diabetes Study (CARDS).
  
  
  METHODS
  A total of 2,838 patients, who were aged 40 to 75 years and had type 2 diabetes without a documented history of cardiovascular disease and without elevated LDL-cholesterol, were recruited from 32 centres in the UK and Ireland and randomly allocated to atorvastatin 10 mg daily (n = 1,428) or placebo (n = 1,410). These subjects were followed-up for a median period of 3.9 years. Direct treatment costs and effectiveness were analysed to provide estimates of cost per endpoint-free year over the trial period for alternative definitions of endpoint, and of cost per life-year gained and cost per quality-adjusted life-year (QALY) gained over a patient's lifetime.
  
  
  RESULTS
  Over the trial period, the incremental cost-effectiveness ratio (ICER) was estimated to be 7,608 pounds per year free of any CARDS primary endpoint; the ICER was calculated to be 4,896 pounds per year free of any cardiovascular endpoint and 4,120 pounds per year free of any study endpoint. Over lifetime, the incremental cost per life-year gained was 5,107 pounds and the cost per QALY was 6,471 pounds (costs and benefits both discounted at 3.5%).
  
  
  CONCLUSIONS
  Primary prevention of cardiovascular disease with atorvastatin is a cost-effective intervention in patients with type 2 diabetes, with the ICER for this intervention falling within the current acceptance threshold ( 20,000 pounds per QALY) specified by the National Institute for Health and Clinical Excellence (NICE).
authors.affiliation: LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. m.raikou@lse.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Raikou
authors.forename: A
authors.initials: A
authors.lastname: McGuire
authors.forename: H M
authors.initials: HM
authors.lastname: Colhoun
authors.forename: D J
authors.initials: DJ
authors.lastname: Betteridge
authors.forename: P N
authors.initials: PN
authors.lastname: Durrington
authors.forename: G A
authors.initials: GA
authors.lastname: Hitman
authors.forename: H A W
authors.initials: HA
authors.lastname: Neil
authors.forename: S J
authors.initials: SJ
authors.lastname: Livingstone
authors.forename: V
authors.initials: V
authors.lastname: Charlton-Menys
authors.forename: J H
authors.initials: JH
authors.lastname: Fuller
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000494:pharmacology*; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006538:Heptanoic Acids / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011322:Primary Prevention; D011758:Pyrroles / Q000494:pharmacology*; D019057:Quality-Adjusted Life Years
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin