Elsevier

Clinical Therapeutics

Volume 30, Issue 7, July 2008, Pages 1345-1357
Clinical Therapeutics

Cost-effectiveness analysis of rosuvastatin versus atorvastatin, simvastatin, and pravastatin from a Canadian health system perspective

https://doi.org/10.1016/S0149-2918(08)80061-6Get rights and content

Abstract

Objective: The primary objective of this study was to assess the cost-effectiveness of the most commonly prescribed doses of rosuvastatin, atorvastatin, simvastatin, and pravastatin for managing various lipid parameters in patients with hypercholesterolemia over a 1-year time horizon from a Canadian health care perspective.

Methods: Incremental cost-effectiveness ratios (ICERs) were estimated for branded rosuvastatin compared with branded atorvastatin, generic simvastatin, and generic pravastatin in patients with hypercholesterolemia in terms of percent reduction in low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, as well as in TC, HDL-C, triglycerides (TG), apolipoprotein (Apo) B, the ApoB/ApoA-I ratio, and attainment of the Canadian LDL-C goal. The pharmacoeconomic model was constructed for a 1-year time horizon using efficacy data from a randomized, openlabel trial including 2268 adults and the wholesale acquisition costs of branded rosuvastatin and atorvastatin and generic simvastatin and pravastatin in British Columbia.

Results: The most commonly prescribed doses of each of the 4 statins in British Columbia were as follows: rosuvastatin 10 mg (75.8% of all rosuvastatin doses); atorvastatin 10 and 20 mg (46.4% and 35.3%, respectively, of all atorvastatin doses); simvastatin 20 and 40 mg (42.5% and 31.8%, respectively, of all simvastatin doses); and pravastatin 20 and 40 mg (55.0% and 34.1%, respectively, of all pravastatin doses). Rosuvastatin 10 mg was dominant (ie, was more effective at a lower cost) relative to atorvastatin 10 and 20 mg, simvastatin 20 and 40 mg, and pravastatin 40 mg in terms of reductions in LDL-C, TC/ HDL-C ratio, TC, ApoB, and ApoB/ApoA-I ratio, increases in HDL-C, and attainment of the LDL-C goal. Compared with pravastatin 20 mg, the ICER per percent reduction in LDL-C, TC/HDL-C ratio, TC, TG, ApoB, or ApoB/ApoA-I or increase in HDL-C ranged from $3.89 to $26.07; the value for 1 additional patient achieving the LDL-C goal was $419.75. When the statin doses were aggregated based on the Canadian statin-utilization pattern, rosuvastatin was dominant relative to atorvastatin on all effectiveness measures evaluated. When rosuvastatin was compared with generic simvastatin and pravastatin, the annual costs for 1 additional patient achieving the LDL-C goal were $144.51 and $373.91, respectively. Based on the sensitivity analysis, rosuvastatin was associated with the highest probability of cost-effectiveness compared with the other statins over a broad range of monetary values per unit of clinical effect.

Conclusion: When percent changes in lipid parameters and rates of LDL-C goal attainment were considered in patients with hypercholesterolemia in British Columbia, rosuvastatin 10 mg was more cost-effective than the most frequently used doses of atorvastatin (10 and 20 mg), generic simvastatin (20 and 40 mg), and generic pravastatin (20 and 40 mg).

References (36)

  • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report

    Circulation

    (2002)
  • IMS Canada. Canadian Drug Store and Hospital Purchases Audit. December...
  • F Espinosa-Larrañaga et al.

    for the Latin American Group

    The importance of low serum levels of high-density lipoprotein cholesterol (HDL-C) as a cardiovascular risk factor. Diab Vasc Dis Res

    (2005)
  • G Yuan et al.

    Hypertriglyceridemia: Its etiology, effects and treatment

    CMAJ

    (2007)
  • JC Fruchart et al.

    New risk factors for atherosclerosis and patient risk assessment

    Circulation

    (2004)
  • A Thompson et al.

    the apolipoprotein B/AI ratio and coronary heart disease: A literature-based metaanalysis of prospective studies

    J Intern Med

    (2006)
  • G Walldius et al.

    The apoB/apoA-I ratio: A strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy—a review of the evidence

    J Intern Med

    (2006)
  • O Faergeman

    Introduction: Apolipoproteins and guidelines for prevention of cardiovascular disease

    J Intern Med

    (2006)
  • Cited by (15)

    • Simultaneous quantification of simvastatin and simvastatin hydroxy acid in blood serum at physiological pH by ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC/MS/MS)

      2014, Journal of Chromatography B: Analytical Technologies in the Biomedical and Life Sciences
      Citation Excerpt :

      Statins are prescribed to treat hypercholesterolemia or high cholesterol. In 2007, Canadian statin sales totalled $1.6 billion, placing them among the most prescribed pharmaceuticals [1]. Statins function by reducing both total and low-density lipoprotein (LDL) cholesterol [2].

    • Evidence-based prediction of statin use with lipid-panel data from the national health and nutrition examination survey

      2012, Value in Health
      Citation Excerpt :

      However, due to the absence of similar studies for the other statins, the evidence does not support superiority with respect to these various endpoints. Cost-effectiveness studies, again primarily sponsored by the market leaders, suggest that the leading statins have good value [37–39], although, again, they do not show that the other statins do not. Finally, at the writing of this article, three of the statins are available as generics (lovastatin since the end of 2001, and pravastatin and simvastatin since 2006), whereas the others are not.

    • Statintherapy in the primary and the secondary prevention of ischaemic cerebrovascular diseases

      2011, International Journal of Cardiology
      Citation Excerpt :

      A recent study study assessed 12,041 patients found that rosuvastatin patients who attained the NCEP ATP III target LDL-C goal had significantly lower titration rates than patients receiving other statins [24]. When percent changes in lipid parameters and rates of LDL-C goal attainment were considered in patients with hypercholesterolemia in British Columbia, rosuvastatin 10 mg was more cost-effective than the most frequently used doses of atorvastatin (10 and 20 mg), generic simvastatin (20 and 40 mg), and generic pravastatin (20 and 40 mg) [26]. These results had been confirmed by another analysis which provided evidence (data were extracted from the STELLAR trial) that prescribing generic statins in Canada does not necessarily translated into the most cost-effective option for treating dyslipidemia; especially as the monetary value of 1% decrease in LDL-C or patients achieving NCEP ATP III target increases.

    View all citing articles on Scopus
    View full text