title: Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population.
abstract: OBJECTIVE
  Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has been demonstrated in several randomized, controlled trials, including the CARDS clinical trial. Based on the clinical CARDS data, the favourable cost effectiveness of atorvastatin 10 mg in patients with type 2 diabetes has been demonstrated in countries such as the UK and France. This study aimed to estimate the cost effectiveness in the Belgian setting of atorvastatin 10 mg compared with no treatment for the primary prevention of CV events in type 2 diabetes patients without a history of CV disease.
  
  
  METHODS
  A Markov model with 1-year cycles was developed to simulate the CV event and death risk according to the therapeutic approach initiated. The transition probabilities for CV events in the 'no statin treatment' group were derived from the risk equations reported from the large UKPDS. Risk reductions from the CARDS clinical trial were used to adjust these CV event probabilities in the atorvastatin 10 mg treatment group. The characteristics of type 2 diabetes patients without a CV history were derived from the Belgian OCAPI survey. The public healthcare payers' perspective was taken into account for costing. The direct medical costs of CV events were based on the Public Health Authorities' hospital database for acute care costs and on the literature for the follow-up costs. The impact on the reimbursement system of generic entry to the market was considered in the drug cost. Costs were valued as at year 2009; costs and outcomes were discounted at 3% and 1.5%, respectively.
  
  
  RESULTS
  Based on a 5-year time horizon, atorvastatin was demonstrated to be cost effective with an incremental cost/quality-adjusted life-year (QALY) of euro 16,681. Over a lifetime horizon (25 years), atorvastatin was demonstrated to be a cost-saving therapeutic intervention. At a threshold of euro 30,000/QALY, atorvastatin had a 98.8% probability of being cost effective.
  
  
  CONCLUSIONS
  Compared with 'no treatment', use of atorvastatin 10 mg as a primary prevention intervention in Belgian type 2 diabetes patients not only improves CV outcomes, but also appears to be cost saving over a lifetime horizon.
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Annemans
authors.forename: S
authors.initials: S
authors.lastname: Marbaix
authors.forename: K
authors.initials: K
authors.lastname: Webb
authors.forename: L
authors.initials: L
authors.lastname: Van Gaal
authors.forename: A
authors.initials: A
authors.lastname: Scheen
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control; D016568:Drugs, Generic / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D014280:Triglycerides / Q000097:blood
chemical_list: D000069059:Atorvastatin; D008076:Cholesterol, HDL; D016568:Drugs, Generic; D006442:Glycated Hemoglobin; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D014280:Triglycerides