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Statins for cardiovascular prevention according to different strategies: a cost analysis
Marcia K Ito1, David Nanchen, Nicolas Rodondi
1Institute of Health Economics and Management, University of Lausanne, Lausanne, Switzerland.
Insights
The European Society of Cardiology (ESC) guidelines for statin treatment in primary prevention of coronary heart disease (CHD) are the most cost-effective. These guidelines offer the lowest cost per year of life gained free of CHD compared to other strategies.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Preventive Cardiology
Background:
- Statins (HMG-CoA reductase inhibitors) are proven to reduce coronary heart disease (CHD) rates.
- The cost-effectiveness of statin therapy for primary CHD prevention requires further evaluation.
Purpose of the Study:
- To estimate the 10-year costs of CHD prevention with statins in Switzerland.
- To compare cost-effectiveness across different international guidelines: ESC, IAS, and ATP-III.
Main Methods:
- Calculated overall 10-year costs, cost per CHD death averted, and cost per year without CHD.
- Utilized sensitivity analysis by adjusting CHD events prevented and treatment costs.
- Modeled costs based on specific assumptions for consultations, cholesterol measurements, and generic statin use.
Main Results:
- ESC, IAS, and ATP-III strategies incurred 10-year costs of 2.2, 3.4, and 4.1 billion Swiss francs, respectively.
- Average cost per year of life gained was lowest with ESC guidelines (SwF352,000), higher in women than men.
- Statin drug costs comprised 45-68% of total preventive costs; ESC remained most cost-effective across sensitivity analyses.
Conclusions:
- Statin-based CHD prevention costs vary significantly by guideline.
- ESC guidelines demonstrate superior cost-effectiveness, offering the lowest cost per year of life gained free of CHD.
Background:
Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established.
Objective:
To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines, over a 10-year period.
Methods:
The overall 10-year costs, costs of one CHD death averted, and of 1 year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS), and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment.
Results:
Using an inflation rate of medical costs of 3%, a single yearly consultation, a single total cholesterol measurement per year, and a generic statin, the overall 10-year costs of the ESC, IAS, and ATP-III strategies were 2.2, 3.4, and 4.1 billion Swiss francs (SwF [SwF1 = $US0.97]). In this scenario, the average cost for 1 year of life gained was SwF352, SwF421, and SwF485 thousand, respectively, and it was always higher in women than in men. In men, the average cost for 1 year of life without CHD was SwF30.7, SwF42.5, and SwF51.9 thousand for the ESC, IAS, and ATP-III strategies, respectively, and decreased with age. Statin drug costs represented between 45% and 68% of the overall preventive cost. Changing the cost of statins, inflation rates, or number of fatal and non-fatal cases of CHD averted showed ESC guidelines to be the most cost effective.
Conclusion:
The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.
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