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Cost-effectiveness and cost-utility analysis of OTC use of simvastatin 10 mg for the primary prevention of myocardial infarction in Iranian men.

Amirsadri M, Hassani A - Daru (2015)

Bottom Line: Two measures of benefits were used in the model; Quality-Adjusted-Life-Years (QALYs) for the CUA and Life-Years-Gained (LYG) for the CEA.No threshold has been determined in Iran for the cost-effectiveness of health-related interventions.However, according to the recommendation of WHO, this intervention can be considered highly cost-effective as its ICER is far less than the reported GDP per capita for Iran by World bank in 2013 ($4763).

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. amirsadri@pharm.mui.ac.ir.

ABSTRACT

Background: Several clinical trials and meta-analyses have shown the advantageous effects of statins in populations with different levels of cardiovascular disease (CVD) risk. Considering the increasing cardiovascular risk among the Iranian population, the cost-effectiveness of the use of simvastatin 10 mg, as an Over-The-Counter (OTC) drug, for the primary prevention of myocardial infarction (MI) was evaluated in this modeling study, from the payer's perspective. The target population is a hypothetical cohort of 45-year CVD healthy men with an average (15%) 10-year CVD risk.

Methods: A semi-Markov model with a life-long time horizon was developed to evaluate the Cost-Utility-Analysis (CUA) and Cost-Effectiveness-Analysis (CEA) of the use of OTC simvastatin 10 mg compared to no-drug therapy. Two measures of benefits were used in the model; Quality-Adjusted-Life-Years (QALYs) for the CUA and Life-Years-Gained (LYG) for the CEA. To examine the robustness of the results, one-way sensitivity analysis and probabilistic sensitivity analysis were applied to the model.

Results: For the base-case scenario with a discount rate of 0% the estimated ICERs were 1113 USD/QALY and 935USD/LYG per patient (using governmental tariffs). No threshold has been determined in Iran for the cost-effectiveness of health-related interventions. However, according to the recommendation of WHO, this intervention can be considered highly cost-effective as its ICER is far less than the reported GDP per capita for Iran by World bank in 2013 ($4763).

Conclusions: This modeling study showed that the use of an OTC low dose statin (simvastatin 10 mg) for the primary prevention of myocardial infarction (MI) in 45-year men with a 10-year CVD risk of 15% could be considered highly cost-effective in Iran, as it meets the WHO threshold of the annual GDP per capita ($4763).

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PSA Scatter plot of Incremental cost/LYG ratio (governmental tariffs)
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Fig6: PSA Scatter plot of Incremental cost/LYG ratio (governmental tariffs)

Mentions: Figures 6 and 7 for the probabilistic sensitivity analysis show that the use of OTC simvastatin 10 mg, compared with no-drug therapy for the primary prevention in 45-year men with a CVD 10-risk of 15 %, resulted in higher costs and more LYG and QALYs gained in all of the simulations. According to the probabilistic sensitivity analysis, estimated incremental cost per QALY gained and incremental cost per LYG are $1138 (95 % confidence interval [CI]: $797-$1595) and $960 (95 % confidence interval [CI]: $663-$1363), respectively. In addition, all the points comparing OTC simvastatin 10 mg with no-drug therapy for the primary prevention fell below the recommended threshold of WHO of GDP per capita (the reported GDP per capita by World bank for Iran in 2013 ($4763)) which means the intervention is highly cost-effective [28].Fig. 6


Cost-effectiveness and cost-utility analysis of OTC use of simvastatin 10 mg for the primary prevention of myocardial infarction in Iranian men.

Amirsadri M, Hassani A - Daru (2015)

PSA Scatter plot of Incremental cost/LYG ratio (governmental tariffs)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4697320&req=5

Fig6: PSA Scatter plot of Incremental cost/LYG ratio (governmental tariffs)
Mentions: Figures 6 and 7 for the probabilistic sensitivity analysis show that the use of OTC simvastatin 10 mg, compared with no-drug therapy for the primary prevention in 45-year men with a CVD 10-risk of 15 %, resulted in higher costs and more LYG and QALYs gained in all of the simulations. According to the probabilistic sensitivity analysis, estimated incremental cost per QALY gained and incremental cost per LYG are $1138 (95 % confidence interval [CI]: $797-$1595) and $960 (95 % confidence interval [CI]: $663-$1363), respectively. In addition, all the points comparing OTC simvastatin 10 mg with no-drug therapy for the primary prevention fell below the recommended threshold of WHO of GDP per capita (the reported GDP per capita by World bank for Iran in 2013 ($4763)) which means the intervention is highly cost-effective [28].Fig. 6

Bottom Line: Two measures of benefits were used in the model; Quality-Adjusted-Life-Years (QALYs) for the CUA and Life-Years-Gained (LYG) for the CEA.No threshold has been determined in Iran for the cost-effectiveness of health-related interventions.However, according to the recommendation of WHO, this intervention can be considered highly cost-effective as its ICER is far less than the reported GDP per capita for Iran by World bank in 2013 ($4763).

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. amirsadri@pharm.mui.ac.ir.

ABSTRACT

Background: Several clinical trials and meta-analyses have shown the advantageous effects of statins in populations with different levels of cardiovascular disease (CVD) risk. Considering the increasing cardiovascular risk among the Iranian population, the cost-effectiveness of the use of simvastatin 10 mg, as an Over-The-Counter (OTC) drug, for the primary prevention of myocardial infarction (MI) was evaluated in this modeling study, from the payer's perspective. The target population is a hypothetical cohort of 45-year CVD healthy men with an average (15%) 10-year CVD risk.

Methods: A semi-Markov model with a life-long time horizon was developed to evaluate the Cost-Utility-Analysis (CUA) and Cost-Effectiveness-Analysis (CEA) of the use of OTC simvastatin 10 mg compared to no-drug therapy. Two measures of benefits were used in the model; Quality-Adjusted-Life-Years (QALYs) for the CUA and Life-Years-Gained (LYG) for the CEA. To examine the robustness of the results, one-way sensitivity analysis and probabilistic sensitivity analysis were applied to the model.

Results: For the base-case scenario with a discount rate of 0% the estimated ICERs were 1113 USD/QALY and 935USD/LYG per patient (using governmental tariffs). No threshold has been determined in Iran for the cost-effectiveness of health-related interventions. However, according to the recommendation of WHO, this intervention can be considered highly cost-effective as its ICER is far less than the reported GDP per capita for Iran by World bank in 2013 ($4763).

Conclusions: This modeling study showed that the use of an OTC low dose statin (simvastatin 10 mg) for the primary prevention of myocardial infarction (MI) in 45-year men with a 10-year CVD risk of 15% could be considered highly cost-effective in Iran, as it meets the WHO threshold of the annual GDP per capita ($4763).

Show MeSH
Related in: MedlinePlus