Cost-effectiveness of statins in the prevention of coronary heart disease events in middle-aged Finnish men.
OBJECTIVE
This study evaluated the long-term cost-effectiveness of atorvastatin 20 mg, rosuvastatin 10 mg and simvastatin 40 mg in primary and secondary prevention of CHD in Finland.


METHODS
The effect of statin therapy on the incidence of CHD and the expected total costs of the disease were described using a Markov state transition model. Due to the limited amount of evidence concerning mortality and morbidity for rosuvastatin, the model was used to transmute the efficiency data of all statins (decrease in total cholesterol) into long-term endpoints (myocardial infarction, death) using risk functions of the FINRISK and 4S studies. The study followed a characterized cohort of 55-year-old Finnish men with an average 3.3-6.6% baseline risk of dying from cardiovascular disease within a 10-year period.


METHODS
Incremental cost-effectiveness ratios (ICERs) for atorvastatin and rosuvastatin, compared with simvastatin, measured as cost of life years gained (euro/LYG) and cost of quality adjusted life years gained (euro/QALY).


RESULTS
The use of rosuvastatin increased the life expectancy by 0.27 years on average (LYG) compared with simvastatin, producing additional 0.08 quality-adjusted life-years (QALYs). Compared with simvastatin, the cost of one LYG with rosuvastatin was euro10 834 and the cost of one QALY gained was euro36 548 (discount rate 5% per annum). Corresponding figures for atorvastatin were euro31 286/LYG and euro105 599/QALY.


CONCLUSIONS
If the decision makers' willingness to pay for a QALY gained is around euro40 000 there is a high probability (>50%) that rosuvastatin represents a cost-effective form of therapy in the prevention of CHD in middle-aged men with an average 3.3-6.6% risk of dying within 10 years from cardiovascular disease. However, the true clinical impact of these results needs confirmation from on-going clinical trials, as the role of rosuvastatin in reducing clinical events is pending, but for simvastatin and atorvastatin established.
Peura
Piia
P
Department of Social Pharmacy, Center for Pharmaceutical Policy and Economics (CEPPE), University of Kuopio, Kuopio, Finland. Piia.Peura@uku.fi
Martikainen
Janne
J
Soini
Erkki
E
Hallinen
Taru
T
Niskanen
Leo
L
D000069059:Atorvastatin; D015331:Cohort Studies; D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005387:Finland; D005464:Fluorobenzenes / Q000191:economics / Q000627:therapeutic use*; D006538:Heptanoic Acids / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011743:Pyrimidines / Q000191:economics / Q000627:therapeutic use*; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use*; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use*
D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin