Cardiovascular and economic outcomes after initiation of lipid-lowering therapy with atorvastatin vs simvastatin in an employed population.
OBJECTIVE
To compare the risk of cardiovascular-related hospitalization, statin adherence, and direct (medical and drug) and indirect (disability and medically related absenteeism) costs in US employees in whom atorvastatin or simvastatin was newly prescribed.


METHODS
Active employees aged 18 to 64 years with a new atorvastatin or simvastatin prescription were identified from a deidentified claims database for 23 privately insured US companies from January 1, 1999, through December 31, 2006. Employees given atorvastatin were matched to those given simvastatin according to propensity scores based on patient characteristics, index statin dose, preindex cardiovascular events, and wage. Outcomes were compared between matched cohorts during the 2-year postindex period, including the risk of cardiovascular-related hospitalization, adherence to the index statin, use of other lipid-lowering drugs, direct medical costs for third-party payers, and indirect costs to employers. Indirect costs were computed as follows: Disability Payments + Daily Wage x Days of Medically Related Absenteeism. Atorvastatin and simvastatin drug costs were imputed using recent pricing to account for the availability of lower-cost generic simvastatin after the study period.


RESULTS
Among 13,584 matched pairs, treatment with atorvastatin vs simvastatin was associated with a reduced risk of cardiovascular-related hospitalization, higher adherence, and less use of other lipid-lowering drugs. The increase in statin costs associated with atorvastatin vs simvastatin therapy was almost completely offset by reductions in medical service and indirect costs.


CONCLUSIONS
In this study, treatment with atorvastatin compared with simvastatin was associated with a reduced risk of cardiovascular events, reduced indirect costs, and a minimal difference in total costs to employers.
Simpson
Ross J
RJ
Division of Cardiology, University of North Carolina, CB #7075, 6th Floor, 099 Manning Dr, Chapel Hill, NC 27599-7075, USA. rsimpson@med.unc.edu
Signorovitch
James
J
Birnbaum
Howard
H
Ivanova
Jasmina
J
Connolly
Cristina
C
Kidolezi
Yohanne
Y
Kuznik
Andreas
A
D000293:Adolescent; D000328:Adult; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006264:Health Benefit Plans, Employee / Q000191:economics*; D017048:Health Care Costs; 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; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011758:Pyrroles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D014481:United States
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin