Fragoulakis Vassilis, Kourlaba Georgia, Maniadakis Nikolaos
Department of Health Services and Management, National School of Public Health, Athens, Greece.
Clinicoecon Outcomes Res. 2012;4:135-43. doi: 10.2147/CEOR.S31376. Epub 2012 May 29.
An economic evaluation was undertaken in order to assess several therapeutic alternatives (rosuvastatin, atorvastatin, simvastatin, and pravastatin) for the prevention of primary and secondary cardiovascular events in high-risk patients in Greece.
A probabilistic Markov model with five distinct states provided estimates over a 20-year time span. The relative effectiveness of comparators was based on the literature. The HellenicSCORE risk equation was used to forecast survival. The transition probabilities from acute myocardial infarction or stroke to death were estimated with reference to the Framingham study. In addition, Framingham scores were used to calculate the probability of nonfatal acute myocardial infarction or nonfatal stroke. Costs were estimated from the perspective of sickness funds and included direct medical costs valued in the year 2012. The total treatment cost accounted for the cost of drugs, routine examinations, and resources expended in the management of acute myocardial infarction, stroke, and death. The utility decrements used are those for the Greek population. A supplementary budget impact analysis was also conducted.
The mean discounted quality-adjusted life years in the case of males for the rosuvastatin arm were 10.18 versus 10.04, 9.94, and 9.88 for atorvastatin, simvastatin, and pravastatin, respectively. The mean total cost was €15,392, €16,438, €17,009, and €17,356 for rosuvastatin, atorvastatin, simvastatin, and pravastatin, respectively. Similar results were obtained in the case of females, while all analyses demonstrated a statistically significant difference at the 95% level of significance. The total burden of 100% (single) use of rosuvastatin in a hypothetical cohort of 100 male patients for one year was €1.47 million versus €1.53 million for atorvastatin, €1.57 million for simvastatin, and €1.59 million for pravastatin.
Rosuvastatin may represent an attractive choice compared with likely alternative existing therapies used in the primary and secondary prevention of cardiovascular events by the National Health Service of Greece.
为评估几种治疗方案（瑞舒伐他汀、阿托伐他汀、辛伐他汀和普伐他汀）对希腊高危患者预防原发性和继发性心血管事件的效果，进行了一项经济学评价。
采用具有五个不同状态的概率马尔可夫模型，在20年时间跨度内进行估计。比较药物的相对疗效基于文献。使用希腊心血管风险评估（HellenicSCORE）风险方程预测生存率。急性心肌梗死或中风到死亡的转移概率参考弗雷明汉研究进行估计。此外，弗雷明汉评分用于计算非致命性急性心肌梗死或非致命性中风的概率。成本从疾病基金的角度进行估计，包括2012年价值的直接医疗成本。总治疗成本包括药物成本、常规检查以及急性心肌梗死、中风和死亡管理中消耗的资源。使用的效用递减是针对希腊人群的。还进行了补充预算影响分析。
男性患者中，瑞舒伐他汀组的平均贴现质量调整生命年为10.18年，阿托伐他汀组为10.04年，辛伐他汀组为9.94年，普伐他汀组为9.88年。瑞舒伐他汀、阿托伐他汀、辛伐他汀和普伐他汀的平均总成本分别为15392欧元、16438欧元、17009欧元和17356欧元。女性患者也得到了类似结果，所有分析在95%显著性水平上均显示出统计学显著差异。在一个假设的100名男性患者队列中，瑞舒伐他汀100%（单次）使用一年的总负担为147万欧元，阿托伐他汀为153万欧元，辛伐他汀为157万欧元，普伐他汀为159万欧元。
与希腊国家卫生服务机构在心血管事件一级和二级预防中可能使用的现有替代疗法相比，瑞舒伐他汀可能是一个有吸引力的选择。
