Valutazione economica dello studio TNT

Abstract

Introduction: the Treating to New Targets (TNT) study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/die provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/die in patients with stable coronary heart disease (CHD). Objective: our aim was to investigate the economic consequence of high dose of atorvastatin in Italian patients with stable coronary heart disease (CHD). Methods: data were derived from the Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease (TNT) study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus usual-dose of atorvastatin (10 mg/die) in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006). Effects were measured in terms of patients free from any event. We considered an observation period of 4.9 years. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. Results: the cost of atorvastatin 10 mg or 80 mg therapy over the 4.9 years period amounted to approximately € 1.6 millions and € 2.5 millions per 1,000 patients respectively. The total cost of atorvastatin high dose was about € 3.7 millions, the incremental cost per patient free from event is about € 12,600. Discussion: this evaluation found that atorvastatin therapy is cost-effective. Sensitivity analysis shows that cost consequences parameters are substantially sensitive to fluctuation.