Pharmacoeconomic analysis of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor therapy for the secondary prevention of coronary heart disease

Abstract

OBJECTIVE: The pharmacoeconomics of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (pravastatin) therapy were evaluated using data from an open-labeled, randomized, controlled trial (PCS: Prevention of Coronary Sclerosis study) with a two-year follow-up period. METHODS: Patients with a serum total cholesterol concentration of between 180 and 219 mg/dL at baseline were randomly assigned to two groups: the pravastatin group (n=54) and the group that did not receive cholesterol-lowering drugs (no-pravastatin group, n=66). A cost-minimization analysis and a cost-effectiveness analysis were then performed from the perspective of a health insurance company, using insurance information obtained from the subjects. In the cost-minimization analysis, the expected costs associated with percutaneous transluminal coronary angioplasty (PTCA) and the pravastatin prescription were compared; the total medication costs between the two groups were also compared. In the cost-effectiveness analysis, the estimated savings per event-free year were calculated. RESULTS: The median cost of a PTCA procedure was 1,323,492 yen. The expected insurance cost for two years was 182,532 yen per patient in the pravastatin group and 224,444 yen per patient in the no-pravastatin group. The cost-minimization analysis showed that the cost of healthcare for the no-pravastatin group was higher than that for the pravastatin group. The mean total cost of medication was 729,849 yen per patient in the pravastatin group and 989,606 yen per patient in the no-pravastatin group. The cost-effectiveness ratio for coronary heart disease was 2,766,994 yen. CONCLUSION: Pravastatin therapy in normocholesterolemic patients with coronary sclerosis seems to have an excellent pharmacoeconomic profile.