Secondary Prevention and Rehabilitation
Cost-effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels,☆☆

https://doi.org/10.1067/mhj.2001.114805Get rights and content

Abstract

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. (Am Heart J 2001;141:727-34.)

Section snippets

Patient characteristics

The cost-effectiveness analysis pertains to survivors of myocardial infarction similar to those enrolled in the CARE trial. In CARE, the mean (SD) age was 59 (9) years. Eighty-six percent of patients were men; among patients assigned to the pravastatin arm, 93% were white, whereas among patients assigned to placebo, 92% were white. The mean cholesterol level at study entry for each group was 209 mg/dL (5.4 mmol/L), with a mean LDL fraction of 139 mg/dL (3.6 mmol/L).3

Effectiveness of therapy

To model the effectiveness

Costs and health-related quality of life

The cost of pravastatin therapy, based on the average dose taken by patients in the active treatment arm in CARE, was $925 per year. The mean cost of other cardiac medications was $1295 per year in the pravastatin group and $1227 per year in the placebo group. The excess medication costs in the pravastatin group were partly offset by savings in hospitalizations (Table I).

Mean health ratings were approximately 1% higher among patients receiving pravastatin: 77.8 versus 77.0 (utility, 0.968 vs

Discussion

Over the last decade, evidence from epidemiologic studies and clinical trials has supported aggressive treatment of hypercholesterolemia and now of average cholesterol levels in patients with CHD.3, 4, 5, 6, 7 Over the same period, statin drugs have surged in popularity because they are effective, well tolerated, and can be taken once or twice a day. Given the expense of statin drugs, however, it has not been clear whether treating patients with CHD who have average cholesterol levels with a

Acknowledgements

We thank Eugene Braunwald, MD, Marc Pfeffer, MD, PhD, and Lemuel Moye, MD, PhD, for helpful input into the analyses; Mae Lipps, RRA, for coding the hospitalization data; Karen Mandell, PharmD, for assigning medication costs; and Loretta Simbartl, MS, for assisting with statistical analyses.

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    Supported by a grant from Bristol-Myers Squibb. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the manuscript.

    ☆☆

    Reprint requests: Joel Tsevat, MD, MPH, Section of Outcomes Research, Division of General Internal Medicine, University of Cincinnati Medical Center, 231 Bethesda Ave, Cincinnati, OH 45267-0535. E-mail: [email protected]

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