Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

Virginia M. Rosen; Douglas C. A. Taylor; Hemangi Parekh; Ankur Pandya; David Thompson; Andreas Kuznik; David D. Waters; Michael Drummond; Milton C. Weinstein

Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

Virginia M. Rosen, Douglas C. A. Taylor, Hemangi Parekh, Ankur Pandya, David Thompson, Andreas Kuznik, David D. Waters, Michael Drummond, Milton C. Weinstein

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

Background: A recent Study Found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-close versus low-dose statin therapy.

Objective: To examine the cost effectiveness of high-close versus low-dose statin therapy in CHIF patients.

Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A 10) in patients with both CHF and coronary heart disease (CHID) [CHF/CHD], using a lifetime Markov model The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based oil clinical trial data. The quality of life and costs were literature based Measures Included costs per life-year saved (LYS) and QALY gained Health consequences and costs were discounted at 3 0% annually Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values.

Results: Literature-based mortality estimates (base case) increased fife-years and QALYs For A80 compared with A10 (incremental cost-effectiveness ratios [ICERs] SUS9600 per LYS. SUS13600 per QALY) At a willingness to pay of SUS100 000 per QALY, A80 was cost effective in 80% of simulations.

A10 dominated A80 when using trial-based mortality estimates (alternative scenario) At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations.

Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US. due to projected gains in life expectancy and health-related quality of life However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A 10 dominates A80.

Original language	English
Pages (from-to)	47-60
Number of pages	14
Journal	Pharmacoeconomics
Volume	28
Issue number	1
Publication status	Published - 2010

Keywords

ACUTE MYOCARDIAL-INFARCTION
PLACEBO-CONTROLLED TRIAL
HIGH-DOSE ATORVASTATIN
GISSI-HF TRIAL
TARGETS TNT
UNITED-STATES
DOUBLE-BLIND
FOLLOW-UP
SURVIVAL
STROKE

Cite this

@article{f04ce994e20e4f95bc2452f49a6ae3b5,

title = "Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US",

abstract = "Background: A recent Study Found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-close versus low-dose statin therapy.Objective: To examine the cost effectiveness of high-close versus low-dose statin therapy in CHIF patients.Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A 10) in patients with both CHF and coronary heart disease (CHID) [CHF/CHD], using a lifetime Markov model The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based oil clinical trial data. The quality of life and costs were literature based Measures Included costs per life-year saved (LYS) and QALY gained Health consequences and costs were discounted at 3 0% annually Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values.Results: Literature-based mortality estimates (base case) increased fife-years and QALYs For A80 compared with A10 (incremental cost-effectiveness ratios [ICERs] SUS9600 per LYS. SUS13600 per QALY) At a willingness to pay of SUS100 000 per QALY, A80 was cost effective in 80% of simulations.A10 dominated A80 when using trial-based mortality estimates (alternative scenario) At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations.Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US. due to projected gains in life expectancy and health-related quality of life However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A 10 dominates A80.",

keywords = "ACUTE MYOCARDIAL-INFARCTION, PLACEBO-CONTROLLED TRIAL, HIGH-DOSE ATORVASTATIN, GISSI-HF TRIAL, TARGETS TNT, UNITED-STATES, DOUBLE-BLIND, FOLLOW-UP, SURVIVAL, STROKE",

author = "Rosen, {Virginia M.} and Taylor, {Douglas C. A.} and Hemangi Parekh and Ankur Pandya and David Thompson and Andreas Kuznik and Waters, {David D.} and Michael Drummond and Weinstein, {Milton C.}",

year = "2010",

language = "English",

volume = "28",

pages = "47--60",

journal = "Pharmacoeconomics",

issn = "1170-7690",

publisher = "Adis International Ltd",

number = "1",

}

TY - JOUR

T1 - Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

AU - Rosen, Virginia M.

AU - Taylor, Douglas C. A.

AU - Parekh, Hemangi

AU - Pandya, Ankur

AU - Thompson, David

AU - Kuznik, Andreas

AU - Waters, David D.

AU - Drummond, Michael

AU - Weinstein, Milton C.

PY - 2010

Y1 - 2010

N2 - Background: A recent Study Found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-close versus low-dose statin therapy.Objective: To examine the cost effectiveness of high-close versus low-dose statin therapy in CHIF patients.Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A 10) in patients with both CHF and coronary heart disease (CHID) [CHF/CHD], using a lifetime Markov model The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based oil clinical trial data. The quality of life and costs were literature based Measures Included costs per life-year saved (LYS) and QALY gained Health consequences and costs were discounted at 3 0% annually Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values.Results: Literature-based mortality estimates (base case) increased fife-years and QALYs For A80 compared with A10 (incremental cost-effectiveness ratios [ICERs] SUS9600 per LYS. SUS13600 per QALY) At a willingness to pay of SUS100 000 per QALY, A80 was cost effective in 80% of simulations.A10 dominated A80 when using trial-based mortality estimates (alternative scenario) At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations.Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US. due to projected gains in life expectancy and health-related quality of life However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A 10 dominates A80.

AB - Background: A recent Study Found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-close versus low-dose statin therapy.Objective: To examine the cost effectiveness of high-close versus low-dose statin therapy in CHIF patients.Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A 10) in patients with both CHF and coronary heart disease (CHID) [CHF/CHD], using a lifetime Markov model The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based oil clinical trial data. The quality of life and costs were literature based Measures Included costs per life-year saved (LYS) and QALY gained Health consequences and costs were discounted at 3 0% annually Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values.Results: Literature-based mortality estimates (base case) increased fife-years and QALYs For A80 compared with A10 (incremental cost-effectiveness ratios [ICERs] SUS9600 per LYS. SUS13600 per QALY) At a willingness to pay of SUS100 000 per QALY, A80 was cost effective in 80% of simulations.A10 dominated A80 when using trial-based mortality estimates (alternative scenario) At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations.Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US. due to projected gains in life expectancy and health-related quality of life However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A 10 dominates A80.

KW - ACUTE MYOCARDIAL-INFARCTION

KW - PLACEBO-CONTROLLED TRIAL

KW - HIGH-DOSE ATORVASTATIN

KW - GISSI-HF TRIAL

KW - TARGETS TNT

KW - UNITED-STATES

KW - DOUBLE-BLIND

KW - FOLLOW-UP

KW - SURVIVAL

KW - STROKE

M3 - Article

SN - 1170-7690

VL - 28

SP - 47

EP - 60

JO - Pharmacoeconomics

JF - Pharmacoeconomics

IS - 1

ER -