Russell M W, Huse D M, Miller J D, Kraemer D F, Hartz S C
ICSL Healthcare Research, Waltham, Massachusetts 02451-7341, USA.
Can J Clin Pharmacol. 2001 Spring;8(1):9-16.
To assess the cost effectiveness of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor therapy, particularly atorvastatin, in primary and secondary prevention of coronary artery disease (CAD) in Canada.
A Markov model was developed in which costs and effectiveness of atorvastatin were compared with those of other statins and with no drug therapy in primary and secondary prevention of CAD.
Cost effectiveness was assessed for cohorts of patients with risk profiles defined by CAD status, age, sex, pretreatment low density lipoprotein cholesterol level and presence of sentinel coronary risk factors. Coronary risk was estimated by using initial and subsequent event coronary risk equations from the Framingham Heart Study, and risk factors were estimated by using Canadian population survey data. Recent estimates of the costs of CAD-related medical care in Canada were used to assign costs to health states and acute coronary events.
Interventions included atorvastatin 10 mg, simvastatin 10 mg, pravastatin 20 mg, fluvastatin 20 mg, lovastatin 20 mg and no pharmacological therapy.
Incremental cost effectiveness ratios (CDN$/year of life gained) relative to no therapy were lowest for atorvastatin and highest for pravastatin across all risk profiles. Atorvastatin was less costly and more effective than lovastatin, pravastatin and simvastatin in primary and secondary prevention, and conferred additional health benefits at a reduced cost per year of life gained compared with fluvastatin.
Atorvastatin was found to be the most cost effective statin in primary and secondary prevention of CAD.
评估3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂疗法，尤其是阿托伐他汀，在加拿大冠心病（CAD）一级和二级预防中的成本效益。
构建了一个马尔可夫模型，在该模型中比较了阿托伐他汀与其他他汀类药物以及无药物治疗在CAD一级和二级预防中的成本和效果。
针对根据CAD状态、年龄、性别、治疗前低密度脂蛋白胆固醇水平和主要冠心病危险因素的存在情况定义风险概况的患者队列评估成本效益。使用弗雷明汉心脏研究的初始和后续事件冠心病风险方程估计冠心病风险，并使用加拿大人口调查数据估计危险因素。利用加拿大近期对CAD相关医疗保健成本的估计，为健康状态和急性冠脉事件分配成本。
干预措施包括阿托伐他汀10毫克、辛伐他汀10毫克、普伐他汀20毫克、氟伐他汀20毫克、洛伐他汀20毫克以及无药物治疗。
在所有风险概况中，相对于无治疗，阿托伐他汀的增量成本效益比（每获得一年生命的加元数）最低，普伐他汀最高。在一级和二级预防中，阿托伐他汀比洛伐他汀、普伐他汀和辛伐他汀成本更低且效果更好，与氟伐他汀相比，每获得一年生命的成本降低，同时带来额外的健康益处。
在CAD一级和二级预防中，阿托伐他汀被发现是最具成本效益的他汀类药物。
