Cost-Efficacy Analysis of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors Based on Results of the STELLAR Trial: Clinical Implications for Therapeutic Selection

Abstract

To compare the cost/1% reduction in low-density lipoprotein cholesterol (LDL) and the cost/patient achieving the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) LDL goal based on the results of the Statin Therapies for Elevated Lipid Levels Compared Across Doses to Rosuvastatin (STELLAR) trial. Cost-efficacy analysis. Investigators in the STELLAR trial evaluated percentage reductions in LDL and achievement of the ATP III LDL goal for various doses of atorvastatin, pravastatin, rosuvastatin, and simvastatin. We derived efficacy estimates for these four statins from the results of this trial. We also derived drug acquisition costs from the average wholesale prices to estimate the cost/1% reduction in LDL levels and the cost/patient achieving the ATP III LDL goal. In the STELLAR trial, doses of rosuvastatin produced reductions in LDL significantly greater than those of equivalent milligram/milligram doses of atorvastatin, simvastatin, or pravastatin. The annual acquisition cost/percentage LDL reduction was lower with rosuvastatin at doses of 10 mg (20.92 dollars), 20 mg (18.28 dollars), and 40 mg (17.42 dollars) than with the other statins analyzed. Rosuvastatin also had a lower average cost/patient achieving the ATP III LDL goal over 6 weeks than that of the other statins. Although the long-term clinical benefits and safety data from the increased LDL reduction achieved with rosuvastatin remain uncertain, rosuvastatin may be the most cost-effective statin among those analyzed in terms of acquisition cost/1% reduction in LDL levels and in terms of patients achieving ATP III LDL goals. On the basis of the efficacy estimates from the STELLAR trial in conjunction with acquisition cost, a potential cost savings could be realized from the use of rosuvastatin.