title: Cost-effectiveness of high, moderate and low-dose statins in the prevention of vascular events in the Brazilian public health system.
abstract: BACKGROUND
  Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.
  
  
  OBJECTIVE
  To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.
  
  
  METHODS
  We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40 mg), intermediate dose; and above 40% (atorvastatin 20-80 mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.
  
  
  RESULTS
  Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.
  
  
  CONCLUSIONS
  Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul.
authors.forename: Rodrigo Antonini
authors.initials: RA
authors.lastname: Ribeiro
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul.
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Instituto de Avaliação de Tecnologia em Saúde.
authors.forename: Patricia Klarmann
authors.initials: PK
authors.lastname: Ziegelmann
authors.affiliation: Instituto de Avaliação de Tecnologia em Saúde.
authors.forename: Steffan Frosi
authors.initials: SF
authors.lastname: Stella
authors.affiliation: Instituto de Cardiologia, Fundação Universitária de Cardiologia.
authors.forename: Jose Luiz da Costa
authors.initials: JL
authors.lastname: Vieira
authors.affiliation: Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Luciane Maria Fabian
authors.initials: LM
authors.lastname: Restelatto
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul.
authors.forename: Carisi Anne
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin; D001938:Brazil; D002318:Cardiovascular Diseases / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; 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*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D011322:Primary Prevention / Q000191:economics; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics; D011758:Pyrroles / Q000008:administration & dosage / Q000191:economics; D018570:Risk Assessment; D012307:Risk Factors; D000068718:Rosuvastatin Calcium; D055502:Secondary Prevention / Q000191:economics; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics
chemical_list: D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin