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Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events.

Gandhi SK, Jensen MM, Fox KM, Smolen L, Olsson AG, Paulsson T - Clinicoecon Outcomes Res (2012)

Bottom Line: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%-85% of simulations relative to atorvastatin or simvastatin 40 mg.Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden.

View Article: PubMed Central - PubMed

Affiliation: AstraZeneca LP, Wilmington, DE, USA.

ABSTRACT

Background: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.

Methods: A PROBABILISTIC MONTE CARLO SIMULATION MODEL BASED ON DATA FROM JUPITER (THE JUSTIFICATION FOR THE USE OF STATINS IN PREVENTION: an Intervention Trial Evaluating Rosuvastatin) was used to estimate the long-term cost-effectiveness of rosuvastatin 20 mg daily versus simvastatin or atorvastatin 40 mg for the prevention of cardiovascular death and morbidity. The three- stage model included cardiovascular event prevention simulating the 4 years of JUPITER, initial prevention beyond the trial, and subsequent cardiovascular event prevention. A Swedish health care payer perspective (direct costs only) was modeled for a lifetime horizon, with 2008/2009 as the costing period. Univariate and probabilistic sensitivity analyses were performed.

Results: The incremental cost per quality-adjusted life-year (QALY) gained with rosuvastatin 20 mg over simvastatin or atorvastatin 40 mg ranged from SEK88,113 (rosuvastatin 20 mg versus simvastatin 40 mg; Framingham risk ≥30%; net avoidance of 34 events/1000 patients) to SEK497,542 (versus atorvastatin 40 mg: Framingham risk ≥20%; net avoidance of 11 events/1000 patients) over a lifetime horizon. Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%-85% of simulations relative to atorvastatin or simvastatin 40 mg. Sensitivity analyses indicated the findings to be robust.

Conclusion: Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden.

No MeSH data available.


Related in: MedlinePlus

(A) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus atorvastatin 40 mg assuming a 95% generic price reduction from brand. (B) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus simvastatin 40 mg assuming a 95% generic price reduction from brand.Abbreviations: CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; Tx, treatment; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; RR, relative risk; QALY, quality adjusted life-year.
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f3-ceor-4-001: (A) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus atorvastatin 40 mg assuming a 95% generic price reduction from brand. (B) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus simvastatin 40 mg assuming a 95% generic price reduction from brand.Abbreviations: CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; Tx, treatment; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; RR, relative risk; QALY, quality adjusted life-year.

Mentions: Sensitivity analyses were applied to assess the change in the ICER estimates across a wide range of statin drug costs, event costs, risks, discontinuation rates, discounting, and utility values. The results of the one-way sensitivity analysis for the lifetime horizon in patients with a Framingham risk ≥20% are summarized in the tornado diagrams in Figure 3. In all scenarios, the variable with the greatest effect on estimated cost-effectiveness was the assumed treatment effectiveness of rosuvastatin in the initial prevention stage. In ≥20% risk patients in the atorvastatin comparison, an assumed 50% increase in rosuvastatin CVE relative risk (0.49 to 0.735, ie, decreased effectiveness) approximately doubled the ICER to SEK1,016,394, whereas a 50% decrease (0.49 to 0.245, ie, increased effectiveness) reduced the ICER to SEK327,523. A similar effect was seen in the simvastatin comparison, where a 50% increase in rosuvastatin CVE relative risk increased the ICER to SEK348,801, and a 50% decrease reduced the ICER to SEK80,777. For patients at ≥30% risk, a 50% increase in rosuvastatin CVE relative risk increased the ICERs to SEK702,023 versus atorvastatin and to SEK231,574 versus simvastatin, whereas a 50% decrease in rosuvastatin CVE relative risk reduced the respective ICERs to SEK254,950 and SEK54,996 (data not shown). The primary CVE risk was the second most important influence on estimated cost effectiveness with both comparisons and in both risk groups. Some variation between groups was seen for the relative importance of the remaining factors, with the applied discount rate, cost of CVEs, and daily cost of rosuvastatin being most influential across groups.


Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events.

Gandhi SK, Jensen MM, Fox KM, Smolen L, Olsson AG, Paulsson T - Clinicoecon Outcomes Res (2012)

(A) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus atorvastatin 40 mg assuming a 95% generic price reduction from brand. (B) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus simvastatin 40 mg assuming a 95% generic price reduction from brand.Abbreviations: CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; Tx, treatment; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; RR, relative risk; QALY, quality adjusted life-year.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3278203&req=5

f3-ceor-4-001: (A) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus atorvastatin 40 mg assuming a 95% generic price reduction from brand. (B) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus simvastatin 40 mg assuming a 95% generic price reduction from brand.Abbreviations: CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; Tx, treatment; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; RR, relative risk; QALY, quality adjusted life-year.
Mentions: Sensitivity analyses were applied to assess the change in the ICER estimates across a wide range of statin drug costs, event costs, risks, discontinuation rates, discounting, and utility values. The results of the one-way sensitivity analysis for the lifetime horizon in patients with a Framingham risk ≥20% are summarized in the tornado diagrams in Figure 3. In all scenarios, the variable with the greatest effect on estimated cost-effectiveness was the assumed treatment effectiveness of rosuvastatin in the initial prevention stage. In ≥20% risk patients in the atorvastatin comparison, an assumed 50% increase in rosuvastatin CVE relative risk (0.49 to 0.735, ie, decreased effectiveness) approximately doubled the ICER to SEK1,016,394, whereas a 50% decrease (0.49 to 0.245, ie, increased effectiveness) reduced the ICER to SEK327,523. A similar effect was seen in the simvastatin comparison, where a 50% increase in rosuvastatin CVE relative risk increased the ICER to SEK348,801, and a 50% decrease reduced the ICER to SEK80,777. For patients at ≥30% risk, a 50% increase in rosuvastatin CVE relative risk increased the ICERs to SEK702,023 versus atorvastatin and to SEK231,574 versus simvastatin, whereas a 50% decrease in rosuvastatin CVE relative risk reduced the respective ICERs to SEK254,950 and SEK54,996 (data not shown). The primary CVE risk was the second most important influence on estimated cost effectiveness with both comparisons and in both risk groups. Some variation between groups was seen for the relative importance of the remaining factors, with the applied discount rate, cost of CVEs, and daily cost of rosuvastatin being most influential across groups.

Bottom Line: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%-85% of simulations relative to atorvastatin or simvastatin 40 mg.Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden.

View Article: PubMed Central - PubMed

Affiliation: AstraZeneca LP, Wilmington, DE, USA.

ABSTRACT

Background: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.

Methods: A PROBABILISTIC MONTE CARLO SIMULATION MODEL BASED ON DATA FROM JUPITER (THE JUSTIFICATION FOR THE USE OF STATINS IN PREVENTION: an Intervention Trial Evaluating Rosuvastatin) was used to estimate the long-term cost-effectiveness of rosuvastatin 20 mg daily versus simvastatin or atorvastatin 40 mg for the prevention of cardiovascular death and morbidity. The three- stage model included cardiovascular event prevention simulating the 4 years of JUPITER, initial prevention beyond the trial, and subsequent cardiovascular event prevention. A Swedish health care payer perspective (direct costs only) was modeled for a lifetime horizon, with 2008/2009 as the costing period. Univariate and probabilistic sensitivity analyses were performed.

Results: The incremental cost per quality-adjusted life-year (QALY) gained with rosuvastatin 20 mg over simvastatin or atorvastatin 40 mg ranged from SEK88,113 (rosuvastatin 20 mg versus simvastatin 40 mg; Framingham risk ≥30%; net avoidance of 34 events/1000 patients) to SEK497,542 (versus atorvastatin 40 mg: Framingham risk ≥20%; net avoidance of 11 events/1000 patients) over a lifetime horizon. Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%-85% of simulations relative to atorvastatin or simvastatin 40 mg. Sensitivity analyses indicated the findings to be robust.

Conclusion: Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden.

No MeSH data available.


Related in: MedlinePlus