ESiOR Oy, P.O. Box 1188, 70211 Kuopio, Finland.
Curr Med Res Opin. 2010 Feb;26(2):389-96. doi: 10.1185/03007990903498653.
To assess which alternative treatment strategies are optimum in terms of cost-effectiveness (EUR/patient treated to target, EUR/PTT) in lowering cholesterol in high-risk patients with elevated LDL-cholesterol (LDL-C) in Sweden.
A probabilistic cost-effectiveness model was developed to estimate the mean expected costs and proportion of patients reaching goal attainment (defined as LDL-C < or =2.5 mmol/L [96.5 mg/dL]) at some point in time within a 52-week period following the initiation of statin therapy. Eight different statin treatment strategies were evaluated. Key data sources used in the modeling were the scientific literature, hospital tariffs and medicine price databases.
Depending on baseline LDL-C and the willingness-to-pay per additional PTT, the cost-effective alternative is always found among four out of the eight assessed treatment strategies (i.e. Simva10 --> Simva20 --> Simva40, Rosu10, Simva20 --> Rosu10 --> Rosu20 --> Rosu40, or Simva20 --> Simva40 --> Rosu20 --> Rosu40). An important finding was that when LDL-C level exceed 4.0 mmol/L (154mg/dL) and when willingness to pay is less than 500 EUR per additional PTT, the optimal treatment strategy would be to initiate cholesterol-lowering treatment directly with rosuvastatin 10 mg.
The results of this study indicate that the optimal approach to initiate lipid-lowering therapy would be to treat patients with the lower baseline LDL-C levels with the least costly treatment strategies, while initiating lipid-lowering treatment with a high-potency statin (rosuvastatin) in patients with moderately high or high baseline LDL-C levels. This recommendation can be assumed to be relevant particularly when the fact that after treatment initiation the majority of Swedish patients will not have any changes in their lipid-lowering medication or dose is taken into account. Finally, since only the short-term results are presented here, it would be valuable to conduct further studies of the long-term cost-effectiveness of different statin treatment strategies that focus on treatment persistence and LDL-C goal attainment in real practice.
评估在瑞典，对于 LDL-胆固醇（LDL-C）升高的高危患者，哪种替代治疗策略在降低胆固醇方面具有成本效益（每治疗达标患者的欧元成本，EUR/PTT）。
开发了一个概率成本效益模型，以估算在开始他汀类药物治疗后 52 周内的某个时间点，达到目标的患者比例（定义为 LDL-C<2.5mmol/L[96.5mg/dL]）和预期的平均成本。评估了八种不同的他汀类药物治疗策略。模型中使用的关键数据来源是科学文献、医院收费和药品价格数据库。
取决于基线 LDL-C 和每增加一个 PTT 的意愿支付金额，八种评估的治疗策略中总有四种是具有成本效益的（即 Simva10->Simva20->Simva40、Rosu10、Simva20->Rosu10->Rosu20->Rosu40，或 Simva20->Simva40->Rosu20->Rosu40）。一个重要的发现是，当 LDL-C 水平超过 4.0mmol/L（154mg/dL）且意愿支付金额低于每增加一个 PTT 500 欧元时，最佳治疗策略将是直接用瑞舒伐他汀 10mg 开始降胆固醇治疗。
本研究结果表明，启动降脂治疗的最佳方法是用成本最低的治疗策略治疗基线 LDL-C 水平较低的患者，而对于基线 LDL-C 水平中度升高或升高的患者，起始使用高效他汀类药物（瑞舒伐他汀）进行降脂治疗。当考虑到治疗开始后，瑞典的大多数患者不会改变其降脂药物或剂量时，这一建议可以被认为是相关的。最后，由于这里只呈现了短期结果，因此进行进一步的研究，评估不同他汀类药物治疗策略的长期成本效益，重点关注实际实践中的治疗持久性和 LDL-C 达标率，将是有价值的。
