title: Cost-effectiveness of statin treatment for primary prevention in conditions of real-world adherence--estimates from the Finnish prescription register.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of statin therapy for primary prevention of coronary heart disease (CHD) events under real-world adherence.
  
  
  METHODS
  A cost-effectiveness model was applied to estimate the expected 10-year costs and health outcomes (in terms of quality-adjusted life-years, QALYs) associated with and without statin treatment (at defined adherence levels) among hypothetical cohorts of Finnish men and women who were initially without established CHD. Treatment efficacy, cost, and quality of life estimates were obtained from published sources. Long-term treatment adherence was measured based on data from the national prescription register.
  
  
  RESULTS
  At an assumed willingness-to-pay threshold of €20,000 per QALY gained, statin treatment with real-world adherence was cost-effective among the older patient groups when the patients' 10-year CHD risk was as high as 20% and did not seem cost-effective in the youngest age groups. Conversely, statin treatment with full adherence was cost-effective for almost all patient groups with a 10-year CHD risk of at least 15%.
  
  
  CONCLUSIONS
  Even though generic statins are now low-cost drugs, treatment adherence seems to have a major impact on the cost-effectiveness of statin treatment in primary prevention. This finding stresses the importance of making a concerted effort for improving adherence among patients on statin therapy to obtain full benefit of the investment in statins. Therefore, novel cost-effective approaches to improve treatment adherence are warranted.
authors.affiliation: Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland; Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland. Electronic address: emma.aarnio@uef.fi.
authors.forename: Emma
authors.initials: E
authors.lastname: Aarnio
authors.affiliation: Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland. Electronic address: maakor@utu.fi.
authors.forename: Maarit J
authors.initials: MJ
authors.lastname: Korhonen
authors.affiliation: Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland; Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland. Electronic address: rihuuppo@utu.fi.
authors.forename: Risto
authors.initials: R
authors.lastname: Huupponen
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland. Electronic address: janne.martikainen@uef.fi.
authors.forename: Janne
authors.initials: J
authors.lastname: Martikainen
mesh_terms: D000368:Aged; D016303:Clinical Pharmacy Information Systems; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055656:Prescriptions; D011322:Primary Prevention; D011336:Probability; D011788:Quality of Life; D012042:Registries
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Adherence; Cost-effectiveness analysis; Primary prevention; Statins