Lachaine Jean, Merikle Elizabeth, Tarride Jean-Eric, Montpetit Martin, Rinfret Stéphane
Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
Clin Ther. 2007 Mar;29(3):519-28. doi: 10.1016/s0149-2918(07)80089-0.
Elevated low-density lipoprotein cholesterol (LDL-C) is an important modifiable risk factor for cardiovascular (CV) disease. Statins differ in their LDL-C-lowering effects and acquisition costs. Atorvastatin and simvastatin are the 2 most commonly used statins in Canada.
This analysis compared the cost-effectiveness of atorvastatin and generic simvastatin in terms of annual drug cost per patient treated to Canadian LDL-C targets. It was conducted from the perspective of the Canadian provincial drug-reimbursement plans.
A hypothetical cohort of 1000 dyslipidemic patients was assigned baseline LDL-C serum concentrations and levels of risk for CV disease based on Canadian population data. Canadian data on statin dosing were combined with efficacy data from a published meta-analysis to determine the proportion of patients who would be expected to achieve LDL-C targets after treatment with atorvastatin or generic simvastatin. Statin acquisition costs were obtained from Ontario and Quebec and reported in 2005 Canadian dollars. The sensitivity of the model to changes in drug costs, effectiveness, and persistence with treatment was tested.
The model predicted that more patients would reach the LDL-C target with atorvastatin than with simvastatin (73% vs 57%, respectively). The mean annual drug cost per patient treated to target was $54 higher with atorvastatin ($905 vs $851). The incremental cost-effectiveness ratio, measured as annual drug cost per additional patient treated to target with atorvastatin, was $1088. The model was sensitive to drug cost and effectiveness assumptions. Incorporating real-life rates of adherence into the model had no significant impact on the results.
In this hypothetical cohort of dyslipidemic patients, treatment with atorvastatin would allow achievement of LDL-C targets in more patients than treatment with simvastatin, at an annual incremental cost of $1088 per additional patient treated to target.
低密度脂蛋白胆固醇（LDL-C）升高是心血管疾病（CV）的一个重要可改变风险因素。他汀类药物在降低LDL-C的效果和购置成本方面存在差异。阿托伐他汀和辛伐他汀是加拿大最常用的两种他汀类药物。
本分析从每位接受治疗患者达到加拿大LDL-C目标的年度药物成本角度，比较阿托伐他汀和辛伐他汀仿制药的成本效益。该分析是从加拿大省级药物报销计划的角度进行的。
根据加拿大人口数据，为一个假设的1000名血脂异常患者队列分配基线LDL-C血清浓度和心血管疾病风险水平。将加拿大他汀类药物给药数据与一项已发表的荟萃分析中的疗效数据相结合，以确定接受阿托伐他汀或辛伐他汀仿制药治疗后预期达到LDL-C目标的患者比例。他汀类药物购置成本来自安大略省和魁北克省，并以2005年加拿大元报告。测试了该模型对药物成本、有效性和治疗持续性变化的敏感性。
该模型预测，与辛伐他汀相比，使用阿托伐他汀达到LDL-C目标的患者更多（分别为73%和57%）。达到目标的每位患者的年均药物成本，阿托伐他汀比辛伐他汀高54美元（905美元对851美元）。以阿托伐他汀治疗后每多一位达到目标的患者的年度药物成本衡量的增量成本效益比为1088美元。该模型对药物成本和有效性假设敏感。将实际依从率纳入模型对结果没有显著影响。
在这个假设的血脂异常患者队列中，与辛伐他汀治疗相比，阿托伐他汀治疗能使更多患者达到LDL-C目标，每多一位达到目标的患者的年度增量成本为1088美元。
