PCV85 COST-EFFECTIVENESS OF ATORVASTATIN IN ACUTE CORONARY SYNDROME (ACS) PATIENTS IN SPAIN

Abstract

OBJECTIVES: To estimate the clinical and economic costs and effects of 2 year treatment with high intensity atorvastatin therapy (80 mg) versus moderate to high dose simvastatin and pravastatin therapies in Spanish patients with acute coronary syndrome (ACS). METHOD(S): Using data from statin trials in ACS (MIRACL, PROVEIT, AtoZ) and priors from published statin meta analyses (CTT, Law), efficacy is estimated based on a Bayesian meta-analysis linking reductions in LDL cholesterol to reductions in secondary cardiovascular (CV) events (MIs, strokes, CV deaths). A Markov model combines estimates of the occurrence of later events; Spanish cost data; and quality of life. Risks are taken from the ACS CURE study. A baseline event risk of 12.1% is used in the first 6 months and 3.89% during later months. The time horizon of the analyses is lifetime (50 years). RESULT(S): Compared to simvastatin 80 mg, the cost per QALY for atorvastatin 80 mg treatment for 2 years is very cost effective at 314,123. Accounting for a 50% price reduction post LOE will result in atorvastatin being even more cost effective. When compared to treatment with pravastatin 40 mg, the cost per QALY is 34,958 for atorvastatin 80 mg, which becomes dominant when the price reduction is included. ICERs improve when risk with age is reduced, lower discount rates are used, and when atorvastatin cost is decreased. CONCLUSION(S): Preliminary findings show that using atorvastatin 80 mg to treat high risk Spanish ACS patients is a very cost-effective intervention, with cost effectiveness ratios of <315,000 versus simvastatin 80 mg and <35,000 versus pravastatin 40 mg. Moreover, following LOE, the cost per QALY becomes extremely cost effective. Univariate sensitivity analyses showed that changes in the costs of atorvastatin, and in treatment duration have the biggest impact on the results. Subsequent probabilistic analyses will be used to further explore uncertainties around the estimates.