Cost-Effectiveness of Pravastatin Therapy
Cost-Effectiveness of Pravastatin Therapy
Background: The objective of this study was to assess the cost-effectiveness of pravastatin therapy in survivors of myocardial infarction with average cholesterol levels.
Methods: We performed a cost-effectiveness analysis based on actual clinical, cost, and health-related quality-of-life data from the Cholesterol and Recurrent Events (CARE) trial. Survival and recurrent coronary heart disease events were modeled from trial data in Markov models, with the use of different assumptions regarding the long-term benefit of therapy.
Results: Pravastatin therapy increased quality-adjusted life expectancy at an incremental cost of $16,000 to $32,000 per quality-adjusted life-year gained. In subgroup analyses, the cost-effectiveness of pravastatin therapy was more favorable for patients >60 years of age and for patients with pretreatment low-density lipoprotein cholesterol levels >125 mg/dL. Results were sensitive to the cost of pravastatin and to assumptions about long-term survival benefits from pravastatin therapy.
Conclusions: The cost-effectiveness of pravastatin therapy in survivors of myocardial infarction with average cholesterol levels compares favorably with other interventions.
Coronary heart disease (CHD) is the leading cause of death in developed countries. In the United States, approximately 460,000 people die of CHD each year, and the annual cost of treating CHD is $55.2 billion. Patients with CHD are at especially high risk of having fatal or nonfatal ischemic events. Because hypercholesterolemia is a major risk factor for such events, there is widespread agreement based on data from randomized trials that secondary prevention of CHD should include aggressive treatment of hypercholesterolemia.
Treatment of hypercholesterolemia among patients who have had myocardial infarction not only reduces morbidity and mortality rates but is also relatively cost-effective. However, the majority of survivors of acute myocardial infarction have average rather than high serum cholesterol levels. Recently, the Cholesterol and Recurrent Events (CARE) trial demonstrated that aggressive cholesterol-lowering therapy with pravastatin reduced the risk of fatal coronary events, nonfatal myocardial infarctions, revascularization procedures (coronary artery bypass surgery and angioplasty), and strokes among survivors of myocardial infarction with average cholesterol levels (eligibility criteria for the CARE trial included a total serum cholesterol level <240 mg/dL [6.2 mmol/L] and a low-density lipoprotein [LDL] level between 115 and 174 mg/dL [3.0 to 4.5 mmol/L]). It is not known, however, whether treating survivors of myocardial infarction who have average cholesterol levels with statin (HMG-CoA reductase inhibitor) drugs, which are relatively expensive, compares favorably in an economic sense with other therapies for such patients. The purpose of this study was to determine the cost-effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels by using data on effectiveness of therapy, resource use, and health-related quality of life directly from the CARE trial.
Background: The objective of this study was to assess the cost-effectiveness of pravastatin therapy in survivors of myocardial infarction with average cholesterol levels.
Methods: We performed a cost-effectiveness analysis based on actual clinical, cost, and health-related quality-of-life data from the Cholesterol and Recurrent Events (CARE) trial. Survival and recurrent coronary heart disease events were modeled from trial data in Markov models, with the use of different assumptions regarding the long-term benefit of therapy.
Results: Pravastatin therapy increased quality-adjusted life expectancy at an incremental cost of $16,000 to $32,000 per quality-adjusted life-year gained. In subgroup analyses, the cost-effectiveness of pravastatin therapy was more favorable for patients >60 years of age and for patients with pretreatment low-density lipoprotein cholesterol levels >125 mg/dL. Results were sensitive to the cost of pravastatin and to assumptions about long-term survival benefits from pravastatin therapy.
Conclusions: The cost-effectiveness of pravastatin therapy in survivors of myocardial infarction with average cholesterol levels compares favorably with other interventions.
Coronary heart disease (CHD) is the leading cause of death in developed countries. In the United States, approximately 460,000 people die of CHD each year, and the annual cost of treating CHD is $55.2 billion. Patients with CHD are at especially high risk of having fatal or nonfatal ischemic events. Because hypercholesterolemia is a major risk factor for such events, there is widespread agreement based on data from randomized trials that secondary prevention of CHD should include aggressive treatment of hypercholesterolemia.
Treatment of hypercholesterolemia among patients who have had myocardial infarction not only reduces morbidity and mortality rates but is also relatively cost-effective. However, the majority of survivors of acute myocardial infarction have average rather than high serum cholesterol levels. Recently, the Cholesterol and Recurrent Events (CARE) trial demonstrated that aggressive cholesterol-lowering therapy with pravastatin reduced the risk of fatal coronary events, nonfatal myocardial infarctions, revascularization procedures (coronary artery bypass surgery and angioplasty), and strokes among survivors of myocardial infarction with average cholesterol levels (eligibility criteria for the CARE trial included a total serum cholesterol level <240 mg/dL [6.2 mmol/L] and a low-density lipoprotein [LDL] level between 115 and 174 mg/dL [3.0 to 4.5 mmol/L]). It is not known, however, whether treating survivors of myocardial infarction who have average cholesterol levels with statin (HMG-CoA reductase inhibitor) drugs, which are relatively expensive, compares favorably in an economic sense with other therapies for such patients. The purpose of this study was to determine the cost-effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels by using data on effectiveness of therapy, resource use, and health-related quality of life directly from the CARE trial.
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