Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System
Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective....
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cardiologia (SBC)
2015-01-01
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| Series: | Arquivos Brasileiros de Cardiologia |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015000100006&lng=en&tlng=en |
| _version_ | 1811253109483110400 |
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| author | Rodrigo Antonini Ribeiro Bruce Bartholow Duncan Patricia Klarmann Ziegelmann Steffan Frosi Stella Jose Luiz da Costa Vieira Luciane Maria Fabian Restelatto Carisi Anne Polanczyk |
| author_facet | Rodrigo Antonini Ribeiro Bruce Bartholow Duncan Patricia Klarmann Ziegelmann Steffan Frosi Stella Jose Luiz da Costa Vieira Luciane Maria Fabian Restelatto Carisi Anne Polanczyk |
| author_sort | Rodrigo Antonini Ribeiro |
| collection | DOAJ |
| description | Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil. |
| first_indexed | 2024-04-12T16:45:49Z |
| format | Article |
| id | doaj.art-13aea66e4abe498f84103b693de23ede |
| institution | Directory Open Access Journal |
| issn | 1678-4170 |
| language | English |
| last_indexed | 2024-04-12T16:45:49Z |
| publishDate | 2015-01-01 |
| publisher | Sociedade Brasileira de Cardiologia (SBC) |
| record_format | Article |
| series | Arquivos Brasileiros de Cardiologia |
| spelling | doaj.art-13aea66e4abe498f84103b693de23ede2022-12-22T03:24:34ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia1678-41702015-01-011041324410.5935/abc.20140173S0066-782X2015000100006Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health SystemRodrigo Antonini RibeiroBruce Bartholow DuncanPatricia Klarmann ZiegelmannSteffan Frosi StellaJose Luiz da Costa VieiraLuciane Maria Fabian RestelattoCarisi Anne PolanczykBackground: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015000100006&lng=en&tlng=enInibidores da Hidroximetilglutaril-CoRedutasesDoenças CardiovascularesPrevençãoAnálise de Custo-BenefícioSistema Único de Saúde |
| spellingShingle | Rodrigo Antonini Ribeiro Bruce Bartholow Duncan Patricia Klarmann Ziegelmann Steffan Frosi Stella Jose Luiz da Costa Vieira Luciane Maria Fabian Restelatto Carisi Anne Polanczyk Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System Arquivos Brasileiros de Cardiologia Inibidores da Hidroximetilglutaril-Co Redutases Doenças Cardiovasculares Prevenção Análise de Custo-Benefício Sistema Único de Saúde |
| title | Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System |
| title_full | Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System |
| title_fullStr | Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System |
| title_full_unstemmed | Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System |
| title_short | Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System |
| title_sort | cost effectiveness of high moderate and low dose statins in the prevention of vascular events in the brazilian public health system |
| topic | Inibidores da Hidroximetilglutaril-Co Redutases Doenças Cardiovasculares Prevenção Análise de Custo-Benefício Sistema Único de Saúde |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015000100006&lng=en&tlng=en |
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