Statin's cost-effectiveness: a Canadian analysis of commonly prescribed generic and brand name statins.
BACKGROUND
Generic statins may be considered as a compelling treatment option for managing dyslipidemia, due to their reduced cost, compared to their brand name equivalent. However, further assessment is needed to determine whether using a particular generic statin is more cost-effective relative to other brand-name statins.


OBJECTIVE
The purpose of this study is to compare the cost-effectiveness of the most commonly prescribed statins in Canada with respect to 1) lowering low-density lipoprotein cholesterol level (LDL-C) and 2) achieving National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) LDL-C goal.


METHODS
The study was conducted from the perspective of Canadian payers over a 1-year time horizon. Clinical data were obtained from the STELLAR trial (n=2268) in which patients received fixed doses of rosuvastatin, atorvastatin, simvastatin and pravastatin. Brand and generic drug costs were based on wholesale acquisition costs. Relative cost-effectiveness was assessed using the net monetary benefit approach (NMB), which allows probabilistic cost-effectiveness comparison of the various treatment options over a wide range of willingness-to-pay (WTP) values for a unit of clinical effect.


RESULTS
Rosuvastatin 10mg was the most cost-effective statin over the largest range of WTP values. Pravastatin 10mg was cost-effective when the clinical outcomes had little or no monetary value. Rosuvastatin 20 mg was more cost-effective at the highest end of the WTP spectrum.


CONCLUSIONS
The result of this analysis provides evidence that prescribing generic statins in Canada does not necessarily translate into the most cost-effective option for treating dyslipidemia; especially as the monetary value of 1% decrease in LDL-C or patients achieving NCEP ATP III target increases.
Tran
Yvan B L
YB
AstraZeneca Canada Inc, Mississauga, Canada.yvan.tran@utoronto.ca
Frial
Tony
T
Miller
Paul S J
PS
D000328:Adult; D000069059:Atorvastatin; D002170:Canada; D008078:Cholesterol, LDL / Q000097:blood; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005464:Fluorobenzenes / Q000191:economics; D006538:Heptanoic Acids / Q000191:economics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D017035:Pravastatin / Q000191:economics; D011743:Pyrimidines / Q000191:economics; D011758:Pyrroles / Q000191:economics; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000191:economics; D013449:Sulfonamides / Q000191:economics; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D016568:Drugs, Generic; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin