Cost-effectiveness of rosuvastatin for primary prevention of cardiovascular events according to Framingham Risk Score in patients with elevated C-reactive protein.
BACKGROUND
The Food and Drug Administration (FDA) recently approved rosuvastatin calcium for prevention of cardiovascular events in patients who have elevated levels of high-sensitivity C-reactive protein (hs-CRP) but not overt hyperlipidemia. The FDA's decision was based primarily on research reported by the JUPITER (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin) Study Group. The cost-effectiveness of such treatment is unknown.


OBJECTIVE
To compare the cost-effectiveness of treatment with rosuvastatin vs standard management, according to Framingham Risk Score (FRS), for the primary prevention of cardiovascular events in patients who have hs-CRP levels of 2.0 mg/L or higher and low-density lipoprotein cholesterol (LDL-C) levels of less than 130 mg/dL.


METHODS
A Markov-type model was used to calculate the incremental cost-effectiveness ratio of rosuvastatin (20 mg daily) vs standard management for the primary prevention of cardiovascular events in patients over a 10-year period. Cost data were obtained from the Centers for Medicare & Medicaid Services and the Red Book drug reference. Health utility measures were obtained from the literature. Cardiovascular event data were obtained directly from the JUPITER Study Group. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted.


RESULTS
Treating patients with rosuvastatin to prevent cardiovascular events based on a hs-CRP level greater than 2.0 mg/L and an LDL-C level of 130 mg/dL or lower would result in estimated incremental cost-effectiveness ratios of $35,455 per quality-adjusted life year (QALY) in patients with an FRS greater than 10% and $90,714 per QALY in patients with an FRS less than or equal to 10%. Results of probabilistic sensitivity analysis suggested that in patients with an FRS greater than 10%, the probability that rosuvastatin is considered cost-effective at $50,000 per QALY is approximately 98%. In patients with an FRS less than or equal to 10%, the probability that rosuvastatin is considered cost-effective at $50,000 per QALY is 0%.


CONCLUSIONS
Compared with standard management, treatment with rosuvastatin is a cost-effective strategy over a 10-year period for preventing cardiovascular events in patients with FRS greater than 10%, elevated hs-CRP levels, and normal LDL-C levels.
MacDonald
Gary P
GP
Rapid City Regional Hospital, Family Medicine Residency Program, 502 E Monroe St, Rapid City, SD 57701-1400, USA. gary.p.macdonald@gmail.com
D002097:C-Reactive Protein / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D005464:Fluorobenzenes / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics; D008390:Markov Chains; D015233:Models, Statistical; D011322:Primary Prevention / Q000191:economics*; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000379:methods; D000068718:Rosuvastatin Calcium; D013023:South Dakota; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D014486:United States Food and Drug Administration
D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein