title: Cost-effectiveness of intensive lipid lowering therapy with 80 mg of atorvastatin, versus 10 mg of atorvastatin, for secondary prevention of cardiovascular disease in Canada.
abstract: BACKGROUND
  The TNT study compared high dose atorvastatin (80 mg) versus moderate atorvastatin (10 mg) treatment in 10,001 patients with stable coronary heart disease (CHD), over 4.9 years. Intensive lipid-lowering with atorvastatin (80 mg) reduced major cardiovascular events by 22%.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of intensive lipid-lowering versus moderate lipid lowering treatment from the perspective of the Canadian Ministries of Health.
  
  
  METHODS
  A lifetime Markov model was developed to predict cardiovascular (CV) events, costs, survival, and quality-adjusted life years (QALYs) for CHD patients receiving 80 mg versus 10 mg of atorvastatin. Predictions were also made for 10- and 5-year horizons. Treatment-specific event risks were used until five years. Beyond year five, equivalent CV risks were assumed for all patients. Medical-care costs and post-event survival were estimated using Canadian data. Health utility scores were obtained from published studies. Benefits and costs were discounted 5% annually. Probabilistic and deterministic sensitivity analyses were performed.
  
  
  RESULTS
  Treatment with atorvastatin (80 mg) over a lifetime horizon resulted in increased costs (Can$16,542 vs. Can$15,365), survival (10.12 vs. 10.03 life years), and QALYs (7.71 vs. 7.61) per patient compared with atorvastatin (10 mg), yielding an incremental cost-effectiveness of Can$12,946 per life year gained and Can$11,969 per QALY. The incremental cost per QALY remained below Can$50,000 in 98.1% of 1000 simulations. Results were robust to variations in event hazard ratios, costs, health utility values, and discount rate.
  
  
  CONCLUSIONS
  Intensive atorvastatin (80 mg) treatment is predicted to be cost-effective versus atorvastatin (10 mg) for CHD patients in Canada.
authors.affiliation: BioMedCom Consultants Inc, Montreal, Canada. monika_wagner@biomedcom.org
authors.forename: Monika
authors.initials: M
authors.lastname: Wagner
authors.forename: Mireille
authors.initials: M
authors.lastname: Goetghebeur
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Merikle
authors.forename: Ankur
authors.initials: A
authors.lastname: Pandya
authors.forename: Paula
authors.initials: P
authors.lastname: Chu
authors.forename: Douglas C A
authors.initials: DC
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D002170:Canada; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011758:Pyrroles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin