title: Cost-effectiveness of extended-release niacin/laropiprant added to a stable simvastatin dose in secondary prevention patients not at cholesterol goal in Germany.
abstract: Coronary heart disease (CHD) remains the leading cause of death in Germany despite statin use to reduce low-density lipoprotein cholesterol (LDL-C) levels; improving lipids beyond LDL-C may further reduce cardiovascular risk. A fixed-dose combination of extended-release niacin (ERN) with laropiprant (LRPT) provides comprehensive lipid management. We adapted a decision-analytic model to evaluate the economic value (incremental cost-effectiveness ratio [ICER] in terms of costs per life-years gained [LYG]) of ERN/LRPT 2 g over a lifetime in secondary prevention patients in a German setting. Two scenarios were modelled: (1) ERN/LRPT 2 g added to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 40 mg; (2) adding ERN/LRPT 2 g compared with titration to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 20 mg. In both scenarios, adding ERN/LRPT was cost-effective relative to simvastatin monotherapy at a commonly accepted threshold of €30,000 per LYG; ICERs for ERN/LRPT were €13,331 per LYG in scenario 1 and €17,684 per LYG in scenario 2. Subgroup analyses showed that ERN/LRPT was cost-effective in patients with or without diabetes, patients aged ≤ 65 or >65 years and patients with low baseline high-density lipoprotein cholesterol levels; ICERs ranged from €10,342 to €15,579 in scenario 1, and from €14,081 to €20,462 in scenario 2. In conclusion, comprehensive lipid management with ERN/LRPT 2 g is cost-effective in secondary prevention patients in Germany who have not achieved LDL-C goal with simvastatin monotherapy.
authors.affiliation: Outcomes Research Department, MSD Sharp & Dohme GmbH, Haar, Germany. galin.michailov@msd.de
authors.forename: Galin V
authors.initials: GV
authors.lastname: Michailov
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Davies
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Krobot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D050171:Dyslipidemias / Q000188:drug therapy* / Q000191:economics; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007211:Indoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009525:Niacin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D018570:Risk Assessment; D055502:Secondary Prevention / Q000191:economics; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D000960:Hypolipidemic Agents; D007211:Indoles; C518174:MK-0524; D009525:Niacin; D019821:Simvastatin