title: Using lower cost statins improves outcomes for normal cholesterol non-diabetic patients.
abstract: BACKGROUND
  The American College of Cardiology recommends considering initiation of cholesterol-lowering therapy in normal cholesterol adults aged 45-70, who are either diabetic or have a 10 year atherosclerotic cardiovascular disease risk higher than 7.5%. Although this policy was shown to be cost-effective, the multi-billion dollar budget impact may limit the adoption, diffusion and overall clinical impact of this therapy.
  
  
  OBJECTIVE
  We examined whether using a substantially lower cost statin (Simvastatin) in a much wider population, while accepting almost-as-good per-patient outcomes can provide better outcomes for the entire intended use population (IUP) under a pre-specified budget constraint.
  
  
  METHODS
  We built a model to compare the outcomes on the entire IUP, and compared branded Rosuvastatin to Simvastatin. Outcomes measured were major adverse cardiovascular events (MACE): cardiovascular death, stroke, myocardial infarction, and hospitalization for revascularization or unstable angina.
  
  
  RESULTS
  The branded Rosuvastatin alternative resulted in the prevention of 6,571 MACE compared to 311,698 MACE with Simvastatin, and 83,120 MACE with generic Rosuvastatin.
  
  
  CONCLUSIONS
  Under budget constraints, using Simvastatin instead of branded Rosuvastatin resulted in a 47 fold increase of prevention of MACE for the entire IUP. These results should be considered while initiating statin therapy in this target population.
authors.affiliation: a Department of Technology Marketing , Sapir College , Israel.
authors.forename: Ronen
authors.identifier: http://orcid.org/0000-0002-6058-8665
authors.initials: R
authors.lastname: Arbel
authors.affiliation: b Department of Health Systems Management, Faculty of Health Sciences and The Guilford-Glazer Faculty of Business and Management , Ben-Gurion University of the Negev , Beer-Sheva , Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D016527:Drug Costs; D016568:Drugs, Generic / Q000008:administration & dosage / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D008962:Models, Theoretical; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D000068718:Rosuvastatin Calcium / Q000008:administration & dosage* / Q000191:economics; D019821:Simvastatin / Q000008:administration & dosage* / Q000191:economics; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D019821:Simvastatin
keywords: Primary prevention; cardiovascular outcomes; cost of therapy; cost-effectiveness; statin therapy