Clinical InvestigationOutcomes, Health Policy and Managed CareLong-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: Results from the Treating to New Targets (TNT) Trial
Section snippets
Overview of design and primary clinical results in TNT
Patients eligible for TNT were 35 to 75 years of age at entry into the trial (July 1998 to December 1999) and had clinically evident CAD involving a previous MI, previous or current angina with objective evidence of atherosclerosis, or previous coronary revascularization. The qualifying event had to be between 1 month and 5 years before screening.5 At the end of an open-label run-in phase with low-dose atorvastatin, patients were eligible for randomization if their LDL cholesterol levels
Baseline characteristics and clinical outcomes in US patients by intention-to-treat
Baseline demographic and clinical characteristics were very well balanced by randomized treatment assignment within the 5,308 US patients, with 2,656 patients randomized to the low-dose arm and 2,652 patients randomized to the high-dose arm (Table I). There were no significant differences in demographics, clinical history, or baseline lipid values.
Clinical outcome results in the US cohort were consistent with the overall trial, with a significantly lower primary composite end point event rate
Discussion
Our study demonstrates that intensive lipid-lowering therapy with high-dose atorvastatin therapy relative to moderate lipid-lowering therapy with low-dose atorvastatin reduced the costs associated with cardiovascular complications in the US TNT cohort to an extent that recouped almost all the extra cost of therapy. At the end of 5 years, the net cost of the high-dose arm was $252. Furthermore, examination of the patterns of costs and cost savings over time showed that there was approximate cost
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