Araujo Denizar Vianna, Ribeiro de Souza Camila Pepe, Bahia Luciana Ribeiro, Rey Helena Cramer Veiga, Dos Santos Junior Braulio, Tura Bernardo Rangel, Berwanger Otavio, Buehler Anna Maria, Silva Marcus Tolentino
Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S29-32. doi: 10.1016/j.jval.2011.05.024.
The objective of this study is to perform an economic evaluation analyzing the treatment with atorvastatin and simvastatin in comparison to placebo treatment, within the Brazilian Public Healthcare System (SUS) scenario, for patients with high risk of cardiovascular disease; analyzing if the additional cost related to statin treatment is justified by the clinical benefits expected, in terms of cardiovascular event and mortality reduction.
Cardiovascular event risk and mortality risk were used as outcomes. Statin efficacy at LDL-c and cardiovascular events levels lowering data was obtained from a systematic review of literature. A decision analytic model was developed to perform a cost-effectiveness analysis comparing atorvastatin 10mg/day and simvastatin 40 mg/day to placebo treatment in patients with dyslipidemia in Brazil. The target population of this study was a hypothetic cohort of men and women with a mean age of 50 years old and high risk of cardiovascular disease. The model includes only direct costs obtained from Ambulatory and Hospital Information System and Price Database of Brazilian Ministry of Health. The comparative cost-effectiveness analysis itself was done through Excel spreadsheets covering a 5 -years time horizon.
The result shows that atorvastatin 10mg/day in comparison to placebo has higher cost with higher effectiveness in the time horizon of 5 years (Incremental Cost Effectiveness Ratio of R$ 433.065,05 per life year gained). In this scenario atorvastatin is not cost effective in comparison to placebo. The simvastatin 40 mg/day appears to be a strategy with lower cost and higher effectiveness in comparison to placebo, in the time horizon analyzed (5 years). In the multivariate probabilistic sensitivity analysis, simvastatin showed 53% of the results in the quadrant with greater effectiveness and lower cost.
This study is an important tool for public decision makers. The study can be used in the decision process of increasing cardiovascular disease treatment access with budgetary sustainability for Ministry of Health. In comparison to placebo, the results show that sinvastatin is a cost saving strategy while atorvastatin is not cost effective.
本研究的目的是在巴西公共医疗体系（SUS）的背景下，对心血管疾病高危患者使用阿托伐他汀和辛伐他汀治疗与安慰剂治疗进行经济学评估；分析他汀类药物治疗相关的额外成本是否能通过预期的临床益处（即降低心血管事件和死亡率）得到合理证明。
将心血管事件风险和死亡风险作为研究结果。他汀类药物在降低低密度脂蛋白胆固醇（LDL-c）水平和心血管事件方面的疗效数据来自对文献的系统综述。开发了一个决策分析模型，以对巴西血脂异常患者中阿托伐他汀10毫克/天和辛伐他汀40毫克/天与安慰剂治疗进行成本效益分析。本研究的目标人群是一个假设的队列，其中男性和女性的平均年龄为50岁，心血管疾病风险高。该模型仅包括从门诊和医院信息系统以及巴西卫生部价格数据库获得的直接成本。比较成本效益分析本身通过Excel电子表格在5年的时间范围内进行。
结果显示，在5年的时间范围内，与安慰剂相比，阿托伐他汀10毫克/天成本更高但效果更好（每获得一个生命年的增量成本效益比为433,065.05雷亚尔）。在这种情况下，与安慰剂相比，阿托伐他汀不具有成本效益。在分析的时间范围（5年）内，辛伐他汀40毫克/天与安慰剂相比似乎是一种成本更低且效果更好的策略。在多变量概率敏感性分析中，辛伐他汀在象限中的结果显示，53%的结果具有更高的效果和更低的成本。
本研究是公共决策者的重要工具。该研究可用于卫生部在增加心血管疾病治疗可及性并保持预算可持续性的决策过程中。与安慰剂相比，结果表明辛伐他汀是一种节省成本的策略，而阿托伐他汀不具有成本效益。
