title: Cost-effectiveness of single agent, uptitration and switching statin treatment strategies for lipid lowering in Sweden.
abstract: OBJECTIVE
  To assess which alternative treatment strategies are optimum in terms of cost-effectiveness (EUR/patient treated to target, EUR/PTT) in lowering cholesterol in high-risk patients with elevated LDL-cholesterol (LDL-C) in Sweden.
  
  
  METHODS
  A probabilistic cost-effectiveness model was developed to estimate the mean expected costs and proportion of patients reaching goal attainment (defined as LDL-C < or =2.5 mmol/L [96.5 mg/dL]) at some point in time within a 52-week period following the initiation of statin therapy. Eight different statin treatment strategies were evaluated. Key data sources used in the modeling were the scientific literature, hospital tariffs and medicine price databases.
  
  
  RESULTS
  Depending on baseline LDL-C and the willingness-to-pay per additional PTT, the cost-effective alternative is always found among four out of the eight assessed treatment strategies (i.e. Simva10 --> Simva20 --> Simva40, Rosu10, Simva20 --> Rosu10 --> Rosu20 --> Rosu40, or Simva20 --> Simva40 --> Rosu20 --> Rosu40). An important finding was that when LDL-C level exceed 4.0 mmol/L (154mg/dL) and when willingness to pay is less than 500 EUR per additional PTT, the optimal treatment strategy would be to initiate cholesterol-lowering treatment directly with rosuvastatin 10 mg.
  
  
  CONCLUSIONS
  The results of this study indicate that the optimal approach to initiate lipid-lowering therapy would be to treat patients with the lower baseline LDL-C levels with the least costly treatment strategies, while initiating lipid-lowering treatment with a high-potency statin (rosuvastatin) in patients with moderately high or high baseline LDL-C levels. This recommendation can be assumed to be relevant particularly when the fact that after treatment initiation the majority of Swedish patients will not have any changes in their lipid-lowering medication or dose is taken into account. Finally, since only the short-term results are presented here, it would be valuable to conduct further studies of the long-term cost-effectiveness of different statin treatment strategies that focus on treatment persistence and LDL-C goal attainment in real practice.
authors.affiliation: ESiOR Oy, P.O. Box 1188, 70211 Kuopio, Finland. janne.martikainen@esior.fi
authors.forename: Janne A
authors.initials: JA
authors.lastname: Martikainen
authors.forename: Erkki
authors.initials: E
authors.lastname: Soini
authors.forename: Thomas
authors.initials: T
authors.lastname: Paulsson
mesh_terms: D000465:Algorithms; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D006287:Health Planning Guidelines; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000191:economics*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000191:economics; D017059:Models, Econometric; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents