Medaxial Group, London, K.
J Med Econ. 2013 Jul;16(7):907-16. doi: 10.3111/13696998.2013.801350. Epub 2013 May 23.
Statins reduce low-density lipoprotein cholesterol (LDL-C) levels, which, when elevated, represent a significant risk factor for cardiovascular (CV) disease. Hyperlipidemic patients at risk of CV events initiated on simvastatin or atorvastatin may be less likely to meet LDL-C goals (defined in National Cholesterol Education Program guidelines) and more likely to experience CV events than patients initiated on rosuvastatin. A 3-year budget impact model was developed to estimate the clinical impact and cost to a US managed care organization (MCO) with 1 million members of initiating high-risk hyperlipidemic patients on rosuvastatin rather than simvastatin or atorvastatin.
A total of 1000 adult patients were assumed to initiate statins. The average baseline LDL-C level was 189 mg/dL. In scenario 1, all patients were initiated on simvastatin or atorvastatin and titrated to a higher dose, or switched to atorvastatin (if initiated on simvastatin) or rosuvastatin; in scenario 2, 50% of the 520 high-risk patients were initiated on rosuvastatin. Drug acquisition and administration costs were considered. Product labeling, clinical trial results, national prescription claims data, and published literature were used to populate the model.
Over 3 years, 75 additional patients reached their LDL-C goal in scenario 2, compared with scenario 1 (633 vs 558, respectively), at an increased cost of $240,628 ($1,415,516 vs $1,174,888, respectively). The additional per member per month (PMPM) cost of scenario 2 was $0.007.
This analysis assumed that statin efficacy is the same in real life as in trials, and used titration and switching patterns not based on patients' goal attainment. However, sensitivity and scenario analyses showed that the model was less sensitive to these parameters than to cost-related parameters.
Initiating high-risk hyperlipidemic patients on rosuvastatin may increase the number of patients reaching LDL-C goal at a relatively modest increase in PMPM cost to an MCO.
他汀类药物可降低低密度脂蛋白胆固醇（LDL-C）水平，当 LDL-C 水平升高时，它是心血管（CV）疾病的一个重要危险因素。与起始用瑞舒伐他汀的患者相比，起始用辛伐他汀或阿托伐他汀的发生 CV 事件风险高的血脂异常患者更可能无法达到 LDL-C 目标（根据国家胆固醇教育计划指南定义），并且更可能发生 CV 事件。建立了一个 3 年预算影响模型，以评估对于拥有 100 万成员的美国管理式医疗组织（MCO）而言，起始用高风险血脂异常患者用瑞舒伐他汀而非辛伐他汀或阿托伐他汀的临床影响和成本。
假设共有 1000 例成年患者起始用他汀类药物。平均基线 LDL-C 水平为 189mg/dL。在方案 1 中，所有患者起始用辛伐他汀或阿托伐他汀，并滴定至更高剂量，或换用阿托伐他汀（如果起始用辛伐他汀）或瑞舒伐他汀；在方案 2 中，520 例高危患者中的 50%起始用瑞舒伐他汀。考虑了药物获取和管理成本。使用产品标签、临床试验结果、全国处方索赔数据和已发表的文献来填充模型。
在 3 年内，方案 2 中有 75 例患者达到 LDL-C 目标，而方案 1 中为 633 例（分别为 75 例和 633 例），成本增加 240628 美元（分别为 1174888 美元和 1415516 美元）。方案 2 的每名成员每月额外成本为 0.007 美元。
该分析假设他汀类药物的疗效在现实生活中与临床试验中相同，并且使用了不基于患者目标实现的滴定和转换模式。但是，敏感性和方案分析表明，该模型对这些参数的敏感性低于对成本相关参数的敏感性。
起始用高风险血脂异常患者用瑞舒伐他汀可能会增加达到 LDL-C 目标的患者数量，而管理式医疗组织的每名成员每月的成本仅略有增加。
