Cost-effectiveness analysis of the use of a high-intensity statin compared to a low-intensity statin in the management of patients with familial hypercholesterolaemia.
OBJECTIVE
To estimate, using probabilistic decision-analytic modelling techniques, the cost effectiveness of treating familial hypercholesterolaemia (FH) patients with high-intensity statins compared to treatment with low-intensity statins. For the purpose of this economic analysis, and based on their known differences, statins were categorised as high intensity if they produce greater LDL-cholesterol reductions than simvastatin 40 mg (e.g., simvastatin 80 mg and appropriate doses of atorvastatin and rosuvastatin or combination of statins + ezetimibe).


METHODS
A lifetime Markov model was developed to estimate the incremental cost per quality adjusted life year (QALY) of treating a hypothetical cohort of 1000 FH patients aged between 20 and 70 years. Baseline coronary heart disease risks reported in the NICE TA 94 on statins, and age-adjusted risk of cardiovascular disease reported in the FH population, were used to populate the model. A meta-analysis estimate of the reduction in cardiovascular events from using high-intensity compared with low-intensity statins was obtained from published trials. Results were interpreted using a cost-effectiveness threshold of pound20 000/QALY.


RESULTS
Fewer cardiovascular events and deaths were predicted to occur in the group treated with higher-intensity statins, and the incremental cost-effectiveness ratio (ICER) was estimated at pound11 103/QALY. The ICER remained below the pound20 000 threshold for 20-39-year-olds and 40-59-year-olds, but rose above this threshold in individuals aged over 60 years. One-way sensitivity analysis showed that results were most sensitive to variation in treatment effect on mortality and the cost of high-intensity statins.


CONCLUSIONS
Modelling demonstrates that high-intensity statins are cost-effective for the treatment of younger FH patients. If, as is likely, the relative price of high-intensity statins fall in the future as they come off patent, then their cost effectiveness will improve further.
Nherera
L
L
National Collaborating Centre for Primary Care, Royal College of General Practitioners, London, UK.
Calvert
N W
NW
Demott
K
K
Humphries
S E
SE
Neil
H A W
HA
Minhas
R
R
Thorogood
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics*; D001384:Azetidines / Q000008:administration & dosage / Q000191:economics*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000401:mortality; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics*; D006938:Hyperlipoproteinemia Type II / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012307:Risk Factors
D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe