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A pharmacoeconomic evaluation of statins in the treatment of hypercholesterolaemia in the primary care setting in Spain

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Abstract

Background: Cardiovascular disease is one of the leading causes of death and it has been shown that primary prevention with the HMG-CoA reductase inhibitor (statin) lipid-lowering drugs can reduce cardiovascular events. Acquisition costs vary between statins and this may be an important consideration in the overall cost effectiveness (CE) of different options.

Objective: To perform a CE study of the main statins used in Spain for primary prevention of cardiovascular disease in patients with high cholesterol levels.

Study design: The CE analysis was based on an open-label, prospective, naturalistic, randomised intervention study under usual care conditions in primary care settings in patients with high cholesterol levels (total cholesterol [TC] >240 mg/dL, low-density lipoprotein cholesterol [LDL-C] >160 mg/dL) and one or more cardiovascular risk factors. The analysis was conducted from the perspective of the Spanish National Health System; the year of costing was 2001.

Patients: A total of 161 patients (49.7% males), mean age 65 ± 10.3 years, without evidence of cardiovascular disease were included in the study. Of those, 82.1% were hypertensive, 37.1% had diabetes mellitus and 17.9% were smokers.

Interventions: Forty-eight patients received oral atorvastatin 10 mg/day, 32 received fluvastatin 40 mg/day, 44 received simvastatin 20 mg/day and 37 patients received pravastatin 20 mg/day for 6 months.

Main measurements and results: After 6 months, the therapeutic goals of LDL-C control, according to the recommendations of the Spanish Society of Arteriosclerosis — Consensus-2000, were reached in 62.5%, 43.8%, 45.5% and 40.5% of patients treated with atorvastatin, fluvastatin, simvastatin and pravastatin, respectively. The average CE ratio, expressed as the cost in euros (®) per patient achieving the therapeutic goals, was ®424.3 for atorvastatin, ®503.5 for fluvastatin, ®527.0 for simvastatin and ®683.4 for pravastatin. The incremental CE ratios for atorvastatin versus fluvastatin and simvastatin were ®238.9 and ®149.5, respectively, per additional patient reaching therapeutic goals. Atorvastatin, fluvastatin and simvastatin all dominated pravastatin.

Conclusions: All the statins studied have been shown to be effective for reducing both TC and LDL-C levels. In this study, atorvastatin was the most efficient drug, with the best CE ratio (cost per patient reaching therapeutic goals). Atorvastatin was more effective and less costly than pravastatin, and when compared with fluvastatin or simvastatin the additional cost per additional patient achieving therapeutic goals was <®250.

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Acknowledgements

All authors contributed equally to the conduct of the economic analysis and preparation of the manuscript. All the authors work for the Spanish National Health System and have no conflicts of interest relevant to the content of this manuscript. No funding was used in the preparation of this manuscript.

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Authors and Affiliations

  1. Zone 6 Primary Care Center, Albacete, Spain

    Pedro J. Tárraga-López

  2. Casas Ibáñez Primary Care Center, Albacete, Spain

    Ángel Celada-Rodríguez

  3. Zone 4 Primary Care Center, Albacete, Spain

    Miguel Cerdán-Oliver

  4. Alcaraz Primary Care Center, Albacete, Spain

    Juan Solera-Albero & José M. Ocaña-López

  5. Tarazona Primary Care Center, Albacete, Spain

    Mateo A. López-Cara

  6. Belmonte Primary Care Center, Cuenca, Spain

    Jaime De Miguel-Clave

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  1. Pedro J. Tárraga-López
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Correspondence to Pedro J. Tárraga-López.

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Tárraga-López, P.J., Celada-Rodríguez, Á., Cerdán-Oliver, M. et al. A pharmacoeconomic evaluation of statins in the treatment of hypercholesterolaemia in the primary care setting in Spain. Pharmacoeconomics 23, 275–287 (2005). https://doi.org/10.2165/00019053-200523030-00007

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