Estimating the Impact of Statin Therapy on Direct and Societal Costs in Mexico: A Comparison to Sweden

Abstract

Objectives: Recent studies have shown a high burden of cardiovascular disease (CVD) risk factors in Mexico, potentially signaling rising levels of CVD-related morbidity and mortality. This study models the cost-effectiveness of statins as a class of drugs for the secondary prevention of key coronary heart disease (CHD) and CVD events, to measure the impact of pharmaceutical innovation on a countrylevel basis. Methods: The investigation uses a value of innovation model created for Sweden, the site of many early statin trials, and adapted to Mexico to allow a comparison between emerging and developed settings. An 8-state semi- Markov model was used to simulate the effect of statin use on key health events and disease-related societal impacts. Drug impact was modeled at the class level using relative risk reductions based on meta-analyses of international statin trials. The subject of the base-case analysis was a 55 year-old male with lifetime statin use. Individual level findings were scaled to the total population to enable an investigation of cost and health outcome trends at the country level for all incident cases in 2011. Results: Over an individual's lifetime, the risk of subsequent myocardial infarctions (MIs) and revascularizations decreased in Mexico (MI, RVC: -3.3%,-0.5%) and Sweden (MI, RVC: -5.3%, -1.6%) due to the use of statins. At the population level, statin use produced lifetime direct cost savings (lowered outpatient, inpatient, and institutionalized costs) of USD21M in Mexico, and USD4M in Sweden, as well as indirect costs savings (increased productivity and reduced premature disease-related retirement) of approximately USD50M (Mexico) and USD88M (Sweden). Conclusions: In both countries, direct cost savings were smaller in scale than indirect savings, indicating the high value of societal benefits in both developed and emerging settings. As Mexico's economy continues to grow, the value of investments in health innovation from both a public health and economic perspective will rise.