Cost effectiveness of intensive lipid-lowering treatment for patients with congestive heart failure and coronary heart disease in the US.
BACKGROUND
A recent study found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-dose versus low-dose statin therapy.


OBJECTIVE
To examine the cost effectiveness of high-dose versus low-dose statin therapy in CHF patients.


METHODS
Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A10) in patients with both CHF and coronary heart disease (CHD) [CHF/CHD], using a lifetime Markov model. The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based on clinical trial data. The quality of life and costs were literature based. Measures included costs per life-year saved (LYS) and QALY gained. Health consequences and costs were discounted at 3.0% annually. Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values.


RESULTS
Literature-based mortality estimates (base case) increased life-years and QALYs for A80 compared with A10 (incremental cost-effectiveness ratios [ICERs]: $US9600 per LYS; $US13 600 per QALY). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 80% of simulations. A10 dominated A80 when using trial-based mortality estimates (alternative scenario). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations.


CONCLUSIONS
Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US, due to projected gains in life expectancy and health-related quality of life. However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A10 dominates A80.
Rosen
Virginia M
VM
i3 Innovus, Medford, Massachusetts 02155, USA.
Taylor
Douglas C A
DC
Parekh
Hemangi
H
Pandya
Ankur
A
Thompson
David
D
Kuznik
Andreas
A
Waters
David D
DD
Drummond
Michael
M
Weinstein
Milton C
MC
D003327:Coronary Disease / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use*; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention; D014481:United States
D000960:Hypolipidemic Agents