title: Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy?
abstract: BACKGROUND
  While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients.
  
  
  RESULTS
  Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose-response: rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative.
  
  
  CONCLUSIONS
  Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.
authors: School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK. r.m.ara@sheffield.ac.uk
authors: R
authors: R
authors: Ara
authors: A
authors: A
authors: Pandor
authors: J
authors: J
authors: Stevens
authors: R
authors: R
authors: Rafia
authors: S E
authors: SE
authors: Ward
authors: A
authors: A
authors: Rees
authors: P N
authors: PN
authors: Durrington
authors: T M
authors: TM
authors: Reynolds
authors: A S
authors: AS
authors: Wierzbicki
authors: M
authors: M
authors: Stevenson
mesh_terms: D000069059:Atorvastatin; D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics; D016568:Drugs, Generic / Q000008:administration & dosage* / Q000191:economics*; D005464:Fluorobenzenes / Q000008:administration & dosage / Q000191:economics; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D008390:Markov Chains; D055118:Medication Adherence; D018803:Models, Economic; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics; D011758:Pyrroles / Q000008:administration & dosage / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000068718:Rosuvastatin Calcium; D055502:Secondary Prevention / Q000191:economics*; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016568:Drugs, Generic; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin