Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial

Am Heart J. 2008 Oct;156(4):698-705. doi: 10.1016/j.ahj.2008.05.032. Epub 2008 Sep 5.


Background: In 10,001 patients with stable coronary artery disease (CAD) enrolled in the Treating to New Targets (TNT) trial, 80 mg/d of atorvastatin (high-dose regimen) reduced the composite primary end point of death from CAD, nonfatal myocardial infarction, resuscitation from cardiac arrest, or stroke by 22% relative to 10 mg/d (low-dose regimen).

Methods: We performed an economic analysis of this trial from the US perspective using hospital bills and Medicare physician fees to estimate costs for cardiovascular hospitalizations in all US patients (n = 5,308). Atorvastatin costs were assigned using a discounted average wholesale price. Cost-effectiveness was calculated as the within-trial incremental cost required to prevent one primary end point event with high-dose atorvastatin.

Results: During a mean 4.9-year follow-up, the high-dose arm had fewer potential end point cardiovascular hospitalizations (35% vs 41%, P < .001) and revascularization procedures (16% vs 22%, P < .001). The high-dose regimen was $1 per day more expensive. At the end of 5 years, cumulative incremental cost for the high-dose arm was $252 (95% CI-$722 to +$1,276). With an absolute reduction in the primary end point of 2.8 per 100 treated with the high-dose regimen, the cost to prevent one additional primary end point event was $8,964.

Conclusion: High-dose atorvastatin treatment of 5 years had only a small net incremental cost because of reduced complications and procedures. The cost to prevent one additional primary end point event with high-dose therapy was similar to that for drug-eluting stents versus bare metal stents in stable CAD and for early invasive versus early conservative therapy in acute coronary syndromes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Atorvastatin
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / economics*
  • Coronary Artery Disease / therapy
  • Female
  • Heptanoic Acids / administration & dosage*
  • Heptanoic Acids / economics*
  • Hospital Costs
  • Hospitalization / economics
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics*
  • Male
  • Medicare / economics
  • Middle Aged
  • Myocardial Revascularization / economics
  • Myocardial Revascularization / statistics & numerical data
  • Outcome Assessment, Health Care*
  • Prospective Studies
  • Pyrroles / administration & dosage*
  • Pyrroles / economics*
  • United States


  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Pyrroles
  • Atorvastatin