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The cost implication of primary prevention in the HOPE 3 trial
Andre Lamy1,2,3, Eva Lonn1,2,3, Wesley Tong1
1Population Health Research Institute, DBCVSRI, 20 Copeland Avenue, Hamilton, ON, Canada.
Insights
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) study found rosuvastatin, alone or with candesartan and hydrochlorothiazide (HCT), reduced cardiovascular events. This combination is cost-saving in developed nations but not developing ones, highlighting a need for drug cost reduction.
Area of Science:
- Cardiovascular disease prevention
- Health economics
- Pharmacoeconomics
Background:
- The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial demonstrated that rosuvastatin, with or without candesartan and hydrochlorothiazide (HCT), significantly reduced cardiovascular events in intermediate-risk individuals.
- Primary prevention strategies are crucial for managing cardiovascular disease globally.
Purpose of the Study:
- To assess the cost implications of implementing rosuvastatin and candesartan/HCT in primary cardiovascular prevention across countries with varying economic levels.
- To determine the cost-effectiveness of these drug regimens in developed versus developing nations.
Main Methods:
- Utilized healthcare resource consumption data from the HOPE-3 trial (12,705 participants).
- Applied country-specific costs to calculate average per-patient costs over the 5.6-year study duration.
- Conducted sensitivity analyses using the cheapest equivalent generic substitutes for medications.
Main Results:
- The combination of rosuvastatin with candesartan/HCT was a cost-saving strategy in developed countries (US, Canada, Europe, Australia).
- In developing countries, these treatments remained more expensive, even with generic substitutes, due to higher relative costs adjusted for GDP.
- The cost of generic substitutes was proportionally higher in developing countries compared to developed ones.
Conclusions:
- Rosuvastatin and candesartan/HCT offer a cost-saving approach for primary cardiovascular prevention in developed countries.
- Making these essential medications more affordable in developing countries is critical for wider adoption and improved cardiovascular health outcomes.
- Addressing drug pricing disparities is essential for equitable access to evidence-based cardiovascular prevention therapies.
Aims:
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels.
Methods And Results:
Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries.
Conclusion:
Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use.
Clinical Trial Registration:
HOPE-3 ClinicalTrials.gov number, NCT00468923.
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