Economic evaluation of high-dose (80 mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40 mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial
Economic evaluation of high-dose (80 mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40 mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial
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DOI：
10.1016/s0828-282x(09)70159-x
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发表时间：
2009-11-01
影响因子：
6.2
通讯作者：
Joensson, Bengt
中科院分区：
文献类型：
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作者：
Wagner, Monika;Lindgren, Peter;Joensson, Bengt
背景：通过积极降脂逐步减少终点 (IDEAL) 试验表明，在 4.8 年的中位随访期内，高剂量阿托伐他汀（80 毫克/天）与标准剂量辛伐他汀（20 毫克/天至 40 毫克/天）治疗相比，对 8888 名既往患有心肌梗塞 (MI) 的患者可增加心血管获益。 目的：评估 从加拿大社会的角度来看，高剂量阿托伐他汀与标准剂量辛伐他汀治疗有心肌梗死病史的患者的成本效益。方法：在一项试验内分析中，在意向治疗的基础上按治疗组汇总 IDEAL 试验期间发生的终点相关事件、使用的资源和生产力损失，以计算每次避免事件的增量成本。此外，使用终生马尔可夫模型预测质量调整生存率。过渡概率、损失的工作日、研究药物的使用和心血管住院率均基于 IDEAL 试验数据。住院费用、研究药物费用和生产力费用都包括在内。进行了概率性和确定性敏感性分析。结果：与标准剂量辛伐他汀相比，阿托伐他汀 80 mg 使每位患者的事件减少了 0.099 次，并在 4.8 年的治疗中节省了成本。在整个生命周期中，阿托伐他汀 80 mg 可使每位患者获得 0.023 质量调整生命年 (QALY)，每获得 QALY 的增量成本为 26,795 美元。在 1000 次模拟中，有 78% 的增量成本效益比保持在 50,000 美元/QALY 以下。排除间接成本后，增量成本效益比为 38,834 美元/QALY。结果对基线年龄相对敏感，但在性别、基线低密度脂蛋白胆固醇水平、糖尿病状况和住院费用方面具有稳健性。结论：从加拿大社会的角度来看，对于既往心梗患者，高剂量阿托伐他汀与标准剂量辛伐他汀相比具有成本效益。
BACKGROUND: The Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial demonstrated incremental cardiovascular benefit of treatment with high-dose atorvastatin (80 mg/day) versus standard-dose simvastatin (20 mg/day to 40 mg/day) in 8888 patients with a previous myocardial infarction (MI) over a median follow-up period of 4.8 years.OBJECTIVES: To assess the cost-effectiveness of high-dose atorvastatin versus standard-dose simvastatin treatment in patients with a history of MI from a Canadian societal perspective.METHODS: In a within-trial analysis, end point-related events, resources used and productivity losses occurring during the IDEAL trial were aggregated by treatment arm on an intention-to-treat basis to calculate the incremental cost per event avoided. Additionally, quality-adjusted survival was projected using a lifetime Markov model. Transition probabilities, workdays lost, use of study medication and cardiovascular hospitalization rates were based on IDEAL trial data. Hospitalization, study medication and productivity costs were included. Probabilistic and deterministic sensitivity analyses were performed.RESULTS: Compared with standard-dose simvastatin, atorvastatin 80 mg led to 0.099 fewer events per patient and cost savings over 4.8 years of treatment. Over a lifetime horizon, atorvastatin 80 mg led to 0.023 quality-adjusted life years (QALYs) gained per patient at an incremental cost of $26,795/QALY gained. The incremental cost-effectiveness ratio remained below $50,000/QALY in 78% of 1000 simulations. Exclusion of indirect costs resulted in an incremental cost-effectiveness ratio of $38,834/QALY. Results were relatively sensitive to baseline age, but robust with respect to sex, baseline low-density lipoprotein cholesterol levels, diabetes status and hospitalization costs.CONCLUSION: From a Canadian societal perspective, high-dose atorvastatin is cost-effective compared with standard-dose simvastatin in patients with a previous MI.