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
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 0300-7995Full text not available from this repository.
Official URL: http://dx.doi.org/10.1185/03007990903494934
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).
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.
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.
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|
|Official Date:||March 2010|
|Number of Pages:||8|
|Page Range:||pp. 529-536|
|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|
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