European Heart Journal Advance Access published online on March 19, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm020
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Cost-effectiveness of high-dose atorvastatin compared with regular dose simvastatin
1 European Health Economics, Vasagatan 38, 111 20 Stockholm, Sweden
2 Pfizer Inc., New York, USA
3 Linköping University Hospital, Linköping, Sweden
4 Ullevål University Hospital, Oslo, Norway
5 Stockholm School of Economics, Stockholm, Sweden
Received 9 August 2006; revised 8 February 2007; accepted 15 February 2007.
* Corresponding author. Tel: +46 854 528540; fax: +46 854 528549. E-mail address: peter.lindgren{at}healtheconomics.se
Aims: The aim of the study was to evaluate the long-term cost-effectiveness of high-dose atorvastatin when compared with generic simvastatin for secondary prevention in Denmark, Finland, Norway, and Sweden based on the recently completed IDEAL trial.
Methods and results: The IDEAL trial showed that high-dose treatment with atorvastatin was associated with fewer non-fatal myocardial infarctions (MI) or coronary heart disease death (RR 0.89; 95% CI 0.78–1.01) and major cardiovascular events by (RR 0.87; 95% CI 0.77–0.98) or any coronary event (RR 0.84; 95% CI 0.76–0.91) than simvastatin with no significant difference in the number of serious adverse events. Costs during the trial period was estimated based on the trial data and a Markov model was constructed where the risk of MIs and revascularization procedures and the long-term costs, quality of life, and mortality associated with these events was simulated. Costs were based on resource consumptions recorded in the trial multiplied with recent unit costs from each country. Both direct health care costs and indirect costs (costs from lost production due to work absence) were included. Intervention lasted for the duration of the trial (4.8 years) while health-effects and costs are predicted for the lifespan of the patient. The main outcome was quality adjusted life-years (QALY) gained. High-dose treatment was predicted to lead to a mean increase in survival of 0.049 years per patient and 0.033 QALYs gained. The cost to gain one QALY was predicted to 47 197
(Denmark), 62 639 (Finland), 35 210 (Norway), and 43 667 (Sweden), with cost-effectiveness ratio decreasing with higher risk.
Conclusion: In the prevention of cardiovascular events among patients with a previous MI, high-dose atorvastatin appears to be a cost-effective strategy when compared with generic simvastatin 20–40 mg in Denmark, Norway, and Sweden. In Finland, it is cost-effective in high-risk patients. The key driver of the cost-effectiveness is the price-difference between 80 mg atorvastatin and generic simvastatin.
Key Words: Atorvastatin • Secondary prevention • Heart disease • Costs • Decision modelling
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  P. Kaul Cost-effectiveness of high-dose atorvastatin compared with usual-dose simvastatin: less than IDEAL? Eur. Heart J., June 2, 2007; 28(12): 1405 - 1406. [Full Text] [PDF]
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