Incremental benefit and cost-effectiveness of high-dose statin therapy in high-risk patients with coronary artery disease

Circulation. 2007 May 8;115(18):2398-409. doi: 10.1161/CIRCULATIONAHA.106.667683. Epub 2007 Apr 23.

Abstract

Background: Recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). However, the actual benefit and cost-effectiveness of high-dose statin therapy are unknown.

Methods and results: We designed a Markov model to compare daily high-dose with conventional-dose statin therapy for hypothetical 60-year-old cohorts with ACS and stable CAD over patient lifetime. Pooled estimates for major clinical end points (all-cause mortality, myocardial infarction, stroke, rehospitalization, and revascularization) from relevant clinical trials were incorporated. Incremental benefit was quantified as quality-adjusted life-years (QALYs). Threshold analyses determined at what price difference high-dose statins would yield incremental cost-effective ratios below $50,000, $100,000, and $150,000 per QALY gained. In ACS patients, a high-dose versus conventional-dose statin strategy resulted in a gain of 0.35 QALYs. In threshold analyses, a high-dose statin strategy consistently yielded incremental cost-effective ratios below $30,000 per QALY even under conservative model assumptions. In stable CAD patients, a high-dose statin strategy yielded a gain of only 0.10 QALYs and was sensitive to model assumptions about statin efficacy. The daily cost difference between a high- and conventional-dose statin would need to be <$1.70, $2.65, and $3.55 to yield incremental cost-effective ratios below $50,000, $100,000, and $150,000 per QALY.

Conclusions: High-dose statin therapy is potentially highly effective and cost-effective in patients with ACS. In patients with stable CAD, however, the cost-effectiveness of high-dose statin therapy is highly sensitive to model assumptions about statin efficacy and cost. Use of high-dose statins can be supported on health economic grounds in patients with ACS, but the case is less clear for patients with stable CAD.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Angina, Unstable / economics
  • Angina, Unstable / prevention & control*
  • Angina, Unstable / therapy
  • Cohort Studies
  • Comorbidity
  • Computer Simulation*
  • Coronary Disease / economics
  • Coronary Disease / epidemiology*
  • Coronary Disease / therapy
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Dose-Response Relationship, Drug
  • Hospitalization
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypercholesterolemia / drug therapy*
  • Hypercholesterolemia / economics
  • Hypercholesterolemia / epidemiology
  • Markov Chains
  • Middle Aged
  • Models, Cardiovascular*
  • Myocardial Infarction / economics
  • Myocardial Infarction / prevention & control*
  • Myocardial Infarction / therapy
  • Myocardial Revascularization
  • Quality-Adjusted Life Years
  • Risk
  • Stroke / economics
  • Stroke / prevention & control*
  • Syndrome

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors