Division of Cardiology, University of North Carolina, CB #7075, 6th Floor, 099 Manning Dr, Chapel Hill, NC 27599-7075, USA.
Mayo Clin Proc. 2009 Dec;84(12):1065-72. doi: 10.4065/mcp.2009.0298.
To compare the risk of cardiovascular-related hospitalization, statin adherence, and direct (medical and drug) and indirect (disability and medically related absenteeism) costs in US employees in whom atorvastatin or simvastatin was newly prescribed.
Active employees aged 18 to 64 years with a new atorvastatin or simvastatin prescription were identified from a deidentified claims database for 23 privately insured US companies from January 1, 1999, through December 31, 2006. Employees given atorvastatin were matched to those given simvastatin according to propensity scores based on patient characteristics, index statin dose, preindex cardiovascular events, and wage. Outcomes were compared between matched cohorts during the 2-year postindex period, including the risk of cardiovascular-related hospitalization, adherence to the index statin, use of other lipid-lowering drugs, direct medical costs for third-party payers, and indirect costs to employers. Indirect costs were computed as follows: Disability Payments + Daily Wage x Days of Medically Related Absenteeism. Atorvastatin and simvastatin drug costs were imputed using recent pricing to account for the availability of lower-cost generic simvastatin after the study period.
Among 13,584 matched pairs, treatment with atorvastatin vs simvastatin was associated with a reduced risk of cardiovascular-related hospitalization, higher adherence, and less use of other lipid-lowering drugs. The increase in statin costs associated with atorvastatin vs simvastatin therapy was almost completely offset by reductions in medical service and indirect costs.
In this study, treatment with atorvastatin compared with simvastatin was associated with a reduced risk of cardiovascular events, reduced indirect costs, and a minimal difference in total costs to employers.
比较新处方阿托伐他汀或辛伐他汀的美国员工发生心血管相关住院治疗、他汀类药物依从性以及直接（医疗和药物）和间接（残疾和与医疗相关的旷工）成本的风险。
1999 年 1 月 1 日至 2006 年 12 月 31 日，从 23 家私人保险公司的一个匿名索赔数据库中确定了年龄在 18 至 64 岁之间、新开具阿托伐他汀或辛伐他汀处方的在职员工。根据患者特征、指数他汀类药物剂量、指数前心血管事件和工资等因素，对接受阿托伐他汀的员工与接受辛伐他汀的员工进行倾向评分匹配。在索引后 2 年期间，比较匹配队列之间的结果，包括心血管相关住院治疗风险、指数他汀类药物的依从性、其他降脂药物的使用、第三方支付者的直接医疗费用以及雇主的间接成本。间接成本计算如下：残疾津贴+病假天数x每天工资。使用最近的价格对阿托伐他汀和辛伐他汀的药物成本进行了估算，以考虑到研究期间后更便宜的通用辛伐他汀的可用性。
在 13584 对匹配的患者中，与辛伐他汀相比，阿托伐他汀治疗与心血管相关住院治疗风险降低、依从性提高和其他降脂药物使用减少相关。与阿托伐他汀治疗相比，辛伐他汀治疗导致的他汀类药物成本增加几乎完全被医疗服务和间接成本的降低所抵消。
在这项研究中，与辛伐他汀相比，阿托伐他汀治疗与心血管事件风险降低、间接成本降低以及雇主总成本的微小差异相关。
