Drug Criteria & Outcomes-Comparing costs: HMG-CoA reductase inhibitors
Therapy varies for secondary prevention of MI
A study comparing the costs of the six hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors varied widely in terms of what was deemed clinically necessary to prevent recurrent myocardial infarction (MI) in patients 60 to 85 years old with coronary heart disease.
Based on a standard of achieving a long-term reduction of low-density-lipoprotein (LDL) cholesterol by 35.57% as a necessary prevention, the direct drug cost of therapy ranged from $921 to $2,356 a year, according to researchers at Rush-St. Luke's-Presbyterian Hospital in Chicago.
A key point in the findings was that achieving clinical necessity was dose-dependent as to the effectiveness of the six drugs in the HMG-CoA class.
Specifically, the study found that daily 10 mg or 20 mg doses of atorvastatin reached clinical effectiveness at an annual cost of $921, the lowest cost found.
The second lowest cost was for 80 mg of fluvastatin at $976. Cerivastatin at 0.4 mg cost $1,031 annually; pravastatin 40 mg reached $1,390; 20 mg or 40 mg of simvastatin was $1,488, and 40 mg or 80 mg of lovastatin was $2,356 a year.
The study's authors note two caveats of the study. First, fluvastatin, lovastatin and pravastatin are not available in the dosages that achieve the desired LDL reduction the study used, which has been shown to significantly reduce the risk of acute MI, and the highest marketed dose was used. Second, while data about cerivastatin over the 0.3 mg dose have not been published, researchers were able to cite one study suggesting 0.4 mg reduces LDL cholesterol by 36%.
Other results
The study also calculated the cost per year of life saved in total health care dollars due to prevention of fatal acute MI. Those results were the same in terms of overall ranking. Specifically, the costs were: atorvastatin, $5,421; fluvastatin, $5,790; cerivastatin, $6,158; pravastatin, $8,575; simvastatin, $9,323; and lovastatin, $15,073. The authors note that cost per year of life saved was age-dependent throughout the study.
The study concluded, "The six currently marketed HMG-CoA reductase inhibitors varied widely in cost and effectiveness in producing reductions in the LDL-cholesterol concentrations that have been shown to prevent recurrent MI. The patient's age at time of diagnosis of CHD had a major impact on the cost-effectiveness of the agents. There was an approximately threefold difference in the cost per year of life saved between the most cost-effective and least cost-effective agents.
• William J. Elliott, MD, PhD, Professor of Preventative Medicine, Internal Medicine and Pharmacology, Ruth-Presbyterian-St. Luke's Hospital, Chicago. Telephone: (312) 942-6296.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content