Nherera, L., Calvert, N. W., DeMott, K., Humphries, Steve E., Neil, H. A. W., Minhas, Rubin and Thorogood, Margaret. (2010) Cost-effectiveness analysis of the use of a high-intensity statin compared to a low-intensity statin in the management of patients with familial hypercholesterolaemia. Current Medical Research and Opinion, Vol.26 (No.3). pp. 529-536. ISSN 0300-7995

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Abstract

Objectives: To estimate, using probabilistic decision-analytic modelling techniques, the cost effectiveness of treating familial hypercholesterolaemia (FH) patients with high-intensity statins compared to treatment with low-intensity statins. For the purpose of this economic analysis, and based on their known differences, statins were categorised as high intensity if they produce greater LDL-cholesterol reductions than simvastatin 40 mg (e. g., simvastatin 80 mg and appropriate doses of atorvastatin and rosuvastatin or combination of statins + ezetimibe). Methods: A lifetime Markov model was developed to estimate the incremental cost per quality adjusted life year (QALY) of treating a hypothetical cohort of 1000 FH patients aged between 20 and 70 years. Baseline coronary heart disease risks reported in the NICE TA 94 on statins, and age-adjusted risk of cardiovascular disease reported in the FH population, were used to populate the model. A meta-analysis estimate of the reduction in cardiovascular events from using high-intensity compared with low-intensity statins was obtained from published trials. Results were interpreted using a cost-effectiveness threshold of 20 pound 000/QALY. Results: Fewer cardiovascular events and deaths were predicted to occur in the group treated with higher-intensity statins, and the incremental cost-effectiveness ratio (ICER) was estimated at 11 pound 103/QALY. The ICER remained below the 20 pound 000 threshold for 20-39-year-olds and 40-59-year-olds, but rose above this threshold in individuals aged over 60 years. One-way sensitivity analysis showed that results were most sensitive to variation in treatment effect on mortality and the cost of high-intensity statins. Conclusions: Modelling demonstrates that high-intensity statins are cost-effective for the treatment of younger FH patients. If, as is likely, the relative price of high-intensity statins fall in the future as they come off patent, then their cost effectiveness will improve further.

Item Type:	Journal Article
Subjects:	Q Science > QA Mathematics R Medicine > RA Public aspects of medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Statins (Cardiovascular agents), Hypercholesteremia -- Treatment -- Cost-effectiveness, Markov processes
Journal or Publication Title:	Current Medical Research and Opinion
Publisher:	Informa Healthcare
ISSN:	0300-7995
Date:	March 2010
Volume:	Vol.26
Number:	No.3
Number of Pages:	8
Page Range:	pp. 529-536
Identification Number:	10.1185/03007990903494934
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	AstraZeneca (Firm), Fournier-Solvay Pharmaceutical, GlaxoSmithKline (GSK), Merck Sharp & Dohme (MSD), Pfizer (Firm), sanofi aventis (Firm), British Heart Foundation, Commonwealth Fund
Grant number:	RG3008, PG2005/014
URI:	http://wrap.warwick.ac.uk/id/eprint/6352

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