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A pharmacoeconomic evaluation of the effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes in Spain

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Abstract

To determine the 16-week health economic outcomes of short-term, intensive lipid-lowering therapy with atorvastatin in patients with acute coronary syndrome (ACS) using unit costs from Spain. The total expected cost per patient and the cost per inpatient event avoided were compared for patients on atorvastatin 80 mg daily versus placebo. The analysis was based on clinical outcome data from the MIRACL study. Clinical outcomes measured in this analysis included: death, cardiac arrest, nonfatal myocardial infarction (MI), fatal MI, angina pectoris, stroke, congestive heart failure (CHF), and surgical or percutaneous coronary revascularizations. Unit costs for outcomes were values using 2001 Diagnosis Related Group (DRG) costs in Spain. The cost of a follow-up visit was added to the cost of each outcome in both groups. In the atorvastatin group, monitoring costs were also added. All direct medical costs were taken from the perspective of the Spanish National Health System during a 16-week period. The hospital cost in the atorvastatin group was € 1,921 per patient, compared to € 1,853 in the placebo group. The incremental cost per patient in the atorvastatin group was € 67.47, corresponding to a cost per inpatient event avoided of € 1,760. The cost of atorvastatin for 16 weeks was € 128. Forty-seven percent of this cost of atorvastatin was offset by the cost savings obtained through the reduction of number of events in the atorvastatin group. In Spain, the intensive short-term use of atorvastatin in patients with ACS has a favorable cost-effectiveness. The direct cost of the drug was largely offset by the associated reduction in costs for treating fewer cardiovascular events.

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References

  1. Ministry of Health and Consumption, Spanish Society of Cardiology and Spanish Society of Arteriosclerosis (2000) Cholesterolemia control in Spain, 2000. A tool for cardiovascular disease prevention. Rev Esp Salud Publica 74:215–253

    PubMed  Google Scholar 

  2. British Heart Foundation (2000) European Cardiovascular Disease Statistics. http://www.bhf.org.uk/professionals/index.asp?secondlevel=519. Cited January 2003

  3. Marrugat J, Elosua R, Marti H (2002) Epidemiology of ischaemic heart disease in Spain: estimation of the number of cases and trends from 1997 to 2005. Rev Esp Cardiol 55:337–346

    PubMed  Google Scholar 

  4. Castelli WP (1984) Epidemiology of coronary heart disease: the Framingham study. Am J Med 76:4–12

    CAS  PubMed  Google Scholar 

  5. Neaton JD, Blackburn H, Jacobs D, Kuller L, Lee DJ, Sherwin R, Shih J, Stamler J, Wentworth D (1992) Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Arch Intern Med 152:1490–1500

    Article  CAS  PubMed  Google Scholar 

  6. Davey-Smith G, Shipley MJ, Marmot MG, Rose G (1992) Plasma cholesterol and mortality: The Whitehall Study. JAMA 267:70–76

    PubMed  Google Scholar 

  7. Chen Z, Peto R, Collins R, MacMahon S, Lu J, Li W (1991) Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ 303:276–282

    CAS  PubMed  Google Scholar 

  8. The Scandinavian Simvastatin Survival Study Group (1994) Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344:1383–1389

    PubMed  Google Scholar 

  9. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, Davis BR, Braunwald E (1996) The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 335:1001–1009

    CAS  PubMed  Google Scholar 

  10. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJ (1995) Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 333:1301–1307

    CAS  PubMed  Google Scholar 

  11. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, Langendorfer A, Stein EA, Kruyer W, Gotto AM Jr (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279:1615–1622

    CAS  PubMed  Google Scholar 

  12. Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group (1998) Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 339:1349–1357

    PubMed  Google Scholar 

  13. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators (1998) Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med 338:1488–1497

    Article  PubMed  Google Scholar 

  14. Fragmin and Fast Revascularization during InStability in Coronary artery disease (FRISC II) Investigators (1999) Invasive compared with non-invasive treatment in unstable coronary artery disease: FRISC II prospective randomized multicenter study. Lancet 354:708–715

    Article  PubMed  Google Scholar 

  15. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284:835–842

    Article  CAS  PubMed  Google Scholar 

  16. Bybee KA, Wright RS, Williams BA, Murphy JG, Holmes DR Jr, Kopecky SL (2001) Effect of concomitant or very early statin ad-ministration on in-hospital mortality and reinfarction in patients with acute myocardial infarction. Am J Cardiol 87:771–774

    Article  CAS  PubMed  Google Scholar 

  17. Stenestrand U, Wallentin L, Swedish Registry of Cardiac Intensive Care (2001) Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 285:430–436

    Article  CAS  PubMed  Google Scholar 

  18. Aronow HD, Topol EJ, Roe MT, et al (2001) Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study. Lancet 357:1063–1068

    Article  CAS  PubMed  Google Scholar 

  19. Newby LK, Kristinsson A, Bhapkar MV, et al (2002) SYMPHONY and 2nd SYMPHONY Investigators. Early statin initiation and outcomes in patients with acute coronary syndromes. JAMA 287:3087–3095

    Article  CAS  PubMed  Google Scholar 

  20. Kayikcioglu M, Turkoglu C, Kultursay H, Evrengul H, Can L (1999) The short term results of combined use of pravastatin with thrombolytic therapy in acute myocardial infarction. Circulation 100[Suppl 1]:I-303. Abstract 1586

  21. van Boven AJ, Liem A (2000) Fluvastatin on Risk Diminishing After Acute Myocardial Infarction (FLORIDA). Presented at: American Heart Association Scientific Session 2000, New Orleans, 12–15 November 2000

    Google Scholar 

  22. Arntz HR, Wunderlich W, Schnitzer L, et al (1999) Short- and long-term effects of intensified versus conventional antilipidemic therapy in patients with coronary heart disease: results from the Lipid-Coronary Artery Disease (L-CAD) Study. Z Kardiol 88:582–590

    Article  CAS  PubMed  Google Scholar 

  23. Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 285:1711–1718

    Article  CAS  PubMed  Google Scholar 

  24. Database of Health Costs for Spain. Soikos Institute. Centre d’studies en Economia de la Salut i de la Politica Social SL. Barcelona 2000.

  25. McGhan W (1993) Part I. Pharmacoeconomics and the evaluation of drugs and services. Hosp Formul 23:365–378

    Google Scholar 

  26. Jolicoeur LM, Jones-Grizzle AJ, Boyer JG (1992) Guidelines for performing a pharmacoeconomic analysis. Am J Hosp Pharm 49:1721–1747

    Google Scholar 

  27. O’Brien BJ, Drummond MF, Labelle RJ, Willan A (1994) In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care 32:150–163

    CAS  PubMed  Google Scholar 

  28. Weinstein MC, Stason WB (1997) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 296:716–721

    Google Scholar 

  29. Xuan J, Duong PT, Russo PA (2000) The economic burden of congestive heart failure in a managed care population. Am J Manag Care 6:693–700

    CAS  PubMed  Google Scholar 

  30. Krumholz HM (1998) Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age. Am Heart J 135:523–531

    CAS  PubMed  Google Scholar 

  31. Anonymous (1995) Metropolitan Life Insurance Company Statistical Bulletin. American Heart Association

  32. Hlatky MA (1999) Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Role of economic models in randomized trials. Am Heart J 137:S41–46

    CAS  PubMed  Google Scholar 

  33. Aguilar MD, Fitch K, Lázaro P, Bernstein SJ (2001) The appropriateness of use of percutaneous transluminal coronary angioplasty in Spain. Inter J Cardiol 78:213–221

    Article  CAS  Google Scholar 

  34. Banz K, Schwicker D (1997) Cost-effectiveness of Palmaz-Schatz stenting for patients with coronary artery disease in Spain. J Invas Cardiol 9:41A–46A

    Google Scholar 

  35. Unger F (1995) European survey on cardiac interventions, open heart surgery, PTCA, cardiac catheterization 1993. A preliminary report by the Institute for Cardiac Survey of the European Academy of Sciences and Arts. Cardiovasc Surg 3:569–571

    Article  CAS  PubMed  Google Scholar 

  36. Coll R (1995) Coste-beneficio de los programas de rehabilitación cardíaca. Rev Esp Cardiol 48[Suppl 1]:94–98

    Google Scholar 

  37. Maroto JM, de Pablo C, Morales MD, Artigao R (1996) Rehabilitación cardíaca. Análisis de coste-efectividad. Rev Esp Cardiol 49:753–758

    PubMed  Google Scholar 

  38. Buller N, Gillen D, Casciano R et al (2003) A pharmacoeconomic evaluation of the myocardial ischaemia reduction with aggressive cholesterol lowering (MIRACL) study in the United Kingdom. Pharmacoeconomics 21[Suppl 1]:25–32

  39. Plans-Rubió P, Rovira J (1995) Estudio coste-effectividad de los tratamientos farmacologicos hipolipemiates. Med Clin (Barc) 105 (2):327–332

    Google Scholar 

  40. Spanish Ministry of Health (1994) CMBD databases. Spanish Ministry of Health, Madrid

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Authors and Affiliations

  1. Clinic Biochemistry Department, Hospital Fundación Jiménez Díaz, Madrid, Spain

    Juan Antonio Gómez-Gerique

  2. The Analytica Group, 450 Park Avenue South, New York, NY, 10016, USA

    Roman Casciano & Lee Stern

  3. Health Outcomes Research; Medical Unit, Pfizer SA, Madrid, Spain

    Javier Rejas

Authors
  1. Juan Antonio Gómez-Gerique
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  2. Roman Casciano
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  3. Lee Stern
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  4. Javier Rejas
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Correspondence to Roman Casciano.

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Gómez-Gerique, J.A., Casciano, R., Stern, L. et al. A pharmacoeconomic evaluation of the effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes in Spain. Eur J Health Econom 5, 278–284 (2004). https://doi.org/10.1007/s10198-003-0222-1

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  • DOI: https://doi.org/10.1007/s10198-003-0222-1

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