PCV93 - Cost-Effectiveness Analysis of Atorvastatin Compared to Simvastatin in the Prevention of Cardiovascular Diseases in the Czech Republic

Abstract

To assess the impact of atorvastatin compared to simvastatin use in the Czech Republic on cardiovascular diseases (CVD), Life-Years Gained (LYG) and Quality-Adjusted Life Years (QALY), based on the real proportional consumption of both statins in particular strengths (10 mg, 20 mg, 40 mg). Life-time cost-effectiveness Markov cohort model was developed with 1 year cycle length and 5 health sates, i.e. Alive without CVD, Alive with experience of CVD, Non-fatal CVD, Fatal CVD and Death. The probability of transition among health states were derived from Framingham equations or from SCORE equations (probability of the first non/fatal CVD), Czech life-tables (background mortality) and international cohort studies (probability of subsequent CVD). Patients enter the model with base-line risk characteristics: age, proportions of males, diabetics, smokers, level of systolic blood pressure and cholesterol (total and HDL) level. The efficacy data for particular statin and its strength were derived from latest meta-analyses. Drug acquisition costs of atorvastatin 10 mg and 20 mg were 10% higher compared to simvastatin 20 mg and 40 mg. The costs of fatal, non-fatal CVD and one-year follow-up after CVD were 1,410 EUR, 1,460 EUR and 580 EUR. Probabilistic sensitivity analysis (PSA) using a willingness to pay (WTP) threshold equal to 1 times GDP per capita (14,300 EUR) was applied. Over a life-time horizon, atorvastatin compared to simvastatin provides 8.14 QALYs vs. 8.07 QALYs, 11.33 LYG vs. 11,24 LYG, 44.8% vs. 46.3% of non-fatal CVD and 28.2% vs. 29.4% of fatal CVD. The increment of total costs was 330 EUR for atorvastatin, ICER for atorvastatin vs. simvastatin was then 4,720 EUR/ QALY. The use of atorvastatin generates 0.07 QALYs more compared to simvastatin per patient in the Czech Republic. There is a 98.5% probability of atorvastatin being cost-effective at the selected WTP.