title: [Analysis of cost-effectiveness of simvastatin versus atorvastatin in the secondary prevention of cardiovascular events within the Brazilian public healthcare system].
abstract: OBJECTIVE
  The objective of this study is to perform an economic evaluation analyzing the treatment with atorvastatin and simvastatin in comparison to placebo treatment, within the Brazilian Public Healthcare System (SUS) scenario, for patients with high risk of cardiovascular disease; analyzing if the additional cost related to statin treatment is justified by the clinical benefits expected, in terms of cardiovascular event and mortality reduction.
  
  
  METHODS
  Cardiovascular event risk and mortality risk were used as outcomes. Statin efficacy at LDL-c and cardiovascular events levels lowering data was obtained from a systematic review of literature. A decision analytic model was developed to perform a cost-effectiveness analysis comparing atorvastatin 10mg/day and simvastatin 40 mg/day to placebo treatment in patients with dyslipidemia in Brazil. The target population of this study was a hypothetic cohort of men and women with a mean age of 50 years old and high risk of cardiovascular disease. The model includes only direct costs obtained from Ambulatory and Hospital Information System and Price Database of Brazilian Ministry of Health. The comparative cost-effectiveness analysis itself was done through Excel spreadsheets covering a 5 -years time horizon.
  
  
  RESULTS
  The result shows that atorvastatin 10mg/day in comparison to placebo has higher cost with higher effectiveness in the time horizon of 5 years (Incremental Cost Effectiveness Ratio of R$ 433.065,05 per life year gained). In this scenario atorvastatin is not cost effective in comparison to placebo. The simvastatin 40 mg/day appears to be a strategy with lower cost and higher effectiveness in comparison to placebo, in the time horizon analyzed (5 years). In the multivariate probabilistic sensitivity analysis, simvastatin showed 53% of the results in the quadrant with greater effectiveness and lower cost.
  
  
  CONCLUSIONS
  This study is an important tool for public decision makers. The study can be used in the decision process of increasing cardiovascular disease treatment access with budgetary sustainability for Ministry of Health. In comparison to placebo, the results show that sinvastatin is a cost saving strategy while atorvastatin is not cost effective.
authors.affiliation: Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil. denizarvianna@gmail.com
authors.forename: Denizar Vianna
authors.initials: DV
authors.lastname: Araujo
authors.forename: Camila Pepe
authors.initials: CP
authors.lastname: Ribeiro de Souza
authors.forename: Luciana Ribeiro
authors.initials: LR
authors.lastname: Bahia
authors.forename: Helena Cramer Veiga
authors.initials: HC
authors.lastname: Rey
authors.forename: Braulio
authors.initials: B
authors.lastname: Dos Santos Junior
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: Otavio
authors.initials: O
authors.lastname: Berwanger
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Buehler
authors.forename: Marcus Tolentino
authors.initials: MT
authors.lastname: Silva
mesh_terms: D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D002318:Cardiovascular Diseases / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D005260:Female; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000191:economics*; D019821:Simvastatin / Q000191:economics* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin