Budget impact of rosuvastatin initiation in high-risk hyperlipidemic patients from a US managed care perspective
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1Medaxial Group, London, K. calypso.montouchet@medaxial.com
Insights
Initiating high-risk hyperlipidemic patients on rosuvastatin helps more achieve low-density lipoprotein cholesterol (LDL-C) goals. This approach offers a modest increase in per member per month costs for managed care organizations.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) is a major cardiovascular disease risk factor.
- Current statin therapies (simvastatin, atorvastatin) may not be sufficient for hyperlipidemic patients to reach LDL-C goals.
- Rosuvastatin may offer improved efficacy in achieving LDL-C targets for high-risk patients.
Purpose of the Study:
- To evaluate the clinical impact and cost-effectiveness of initiating high-risk hyperlipidemic patients on rosuvastatin versus simvastatin or atorvastatin.
- To model the budget impact on a US managed care organization (MCO) over a 3-year period.
Main Methods:
- A 3-year budget impact model was developed for a 1 million-member MCO.
- Two scenarios were compared: Scenario 1 (simvastatin/atorvastatin initiation) and Scenario 2 (50% high-risk patients initiated on rosuvastatin).
- Data sources included product labeling, clinical trials, and national prescription claims.
Main Results:
- Scenario 2 resulted in 75 additional patients achieving their LDL-C goal over 3 years compared to Scenario 1 (633 vs. 558).
- The increased cost for Scenario 2 was $240,628, translating to an additional $0.007 per member per month (PMPM).
Conclusions:
- Initiating high-risk hyperlipidemic patients on rosuvastatin can increase the number of patients achieving LDL-C goals.
- This strategy represents a relatively modest increase in PMPM cost for MCOs.
- Model sensitivity analyses indicated cost parameters were more influential than titration or switching patterns.
Introduction:
Statins reduce low-density lipoprotein cholesterol (LDL-C) levels, which, when elevated, represent a significant risk factor for cardiovascular (CV) disease. Hyperlipidemic patients at risk of CV events initiated on simvastatin or atorvastatin may be less likely to meet LDL-C goals (defined in National Cholesterol Education Program guidelines) and more likely to experience CV events than patients initiated on rosuvastatin. A 3-year budget impact model was developed to estimate the clinical impact and cost to a US managed care organization (MCO) with 1 million members of initiating high-risk hyperlipidemic patients on rosuvastatin rather than simvastatin or atorvastatin.
Methods:
A total of 1000 adult patients were assumed to initiate statins. The average baseline LDL-C level was 189 mg/dL. In scenario 1, all patients were initiated on simvastatin or atorvastatin and titrated to a higher dose, or switched to atorvastatin (if initiated on simvastatin) or rosuvastatin; in scenario 2, 50% of the 520 high-risk patients were initiated on rosuvastatin. Drug acquisition and administration costs were considered. Product labeling, clinical trial results, national prescription claims data, and published literature were used to populate the model.
Results:
Over 3 years, 75 additional patients reached their LDL-C goal in scenario 2, compared with scenario 1 (633 vs 558, respectively), at an increased cost of $240,628 ($1,415,516 vs $1,174,888, respectively). The additional per member per month (PMPM) cost of scenario 2 was $0.007.
Limitations:
This analysis assumed that statin efficacy is the same in real life as in trials, and used titration and switching patterns not based on patients' goal attainment. However, sensitivity and scenario analyses showed that the model was less sensitive to these parameters than to cost-related parameters.
Conclusions:
Initiating high-risk hyperlipidemic patients on rosuvastatin may increase the number of patients reaching LDL-C goal at a relatively modest increase in PMPM cost to an MCO.
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