A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention

Scuffham, Paul A. and Chaplin, Stephen (2005) A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention. Clinical Therapeutics, 27 9: 1467-1477. doi:10.1016/j.clinthera.2005.09.012


Author Scuffham, Paul A.
Chaplin, Stephen
Title A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention
Journal name Clinical Therapeutics   Check publisher's open access policy
ISSN 0149-2918
1879-114X
Publication date 2005
Sub-type Article (original research)
DOI 10.1016/j.clinthera.2005.09.012
Volume 27
Issue 9
Start page 1467
End page 1477
Total pages 11
Editor P. Watson
Place of publication Bridgewater, NJ, United States
Publisher Excerpta Medica
Collection year 2005
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730306 Evaluation of health outcomes
321299 Public Health and Health Services not elsewhere classified
Abstract Background: The Lescol Intervention Prevention Study (LIPS) was a multinational randomized controlled trial that showed a 47% reduction in the relative risk of cardiac death and a 22% reduction in major adverse cardiac events (MACEs) from the routine use of fluvastatin, compared with controls, in patients undergoing percutaneous coronary intervention (PCI, defined as angioplasty with or without stents). In this study, MACEs included cardiac death, nonfatal myocardial infarction, and subsequent PCI and coronary artery bypass graft. Diabetes was the greatest risk factor for MACEs. Objective: This study estimated the cost-effectiveness of fluvastatin when used for secondary prevention of MACEs after PCI in people with diabetes. Methods: A post hoc subgroup analysis of patients with diabetes from the LIPS was used to estimate the effectiveness of fluvastatin in reducing myocardial infarction, revascularization, and cardiac death. A probabilistic Markov model was developed using United Kingdom resource and cost data to estimate the additional costs and quality-adjusted life-years (QALYs) gained over 10 years from the perspective of the British National Health Service. The model contained 6 health states, and the transition probabilities were derived from the LIPS data. Crossover from fluvastatin to other lipid-lowering drugs, withdrawal from fluvastatin, and the use of lipid-lowering drugs in the control group were included. Results: In the subgroup of 202 patients with diabetes in the LIPS trial, 18 (15.0%) of 120 fluvastatin patients and 21 (25.6%) of 82 control participants were insulin dependent (P = NS). Compared with the control group, patients treated with fluvastatin can expect to gain an additional mean (SD) of 0.196 (0.139) QALY per patient over 10 years (P < 0.001) and will cost the health service an additional mean (SD) of 10 (E448) (P = NS) (mean [SD] US $16 [$689]). The additional cost per QALY gained was;(51 (US $78). The key determinants of cost-effectiveness included the probabilities of repeat interventions, cardiac death, the cost of fluvastatin, and the time horizon used for the evaluation. Conclusion: Fluvastatin was an economically efficient treatment to prevent MACEs in these patients with diabetes undergoing PCI.
Keyword Lips
Cost-effectiveness
Heart Disease
Qaly
Monte Carlo Simulations
Pharmacology & Pharmacy
Scandinavian-simvastatin-survival
Mrc/bhf Heart Protection
Placebo-controlled Trial
Quality-of-life
Economic-evaluation
Disease
Prevention
Events
Individuals
Statins
Q-Index Code C1
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2006 Higher Education Research Data Collection
Centre for Online Health Publications
 
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