Published Online
on April 23, 2007

A more recent version of this article appeared on May 8, 2007

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Submitted on October 2, 2006
Accepted on March 15, 2007

Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease

Paul S. Chan MD, MSc^*, Brahmajee K. Nallamothu MD, MPH, Hitinder S. Gurm MD, Rodney A. Hayward MD, and Sandeep Vijan MD, MSc

From the University of Michigan Department of Internal Medicine (P.S.C., B.K.N., H.S.G., R.A.H., S.V.), and Veterans Affairs Ann Arbor Health Services Research & Development Center of Excellence (P.S.C., B.K.N., R.A.H., S.V.), Ann Arbor, Mich.

^* To whom correspondence should be addressed. E-mail: paulchan{at}umich.edu.

Background--Recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). However, the actual benefit and cost-effectiveness of high-dose statin therapy are unknown.

Methods and Results--We designed a Markov model to compare daily high-dose with conventional-dose statin therapy for hypothetical 60-year-old cohorts with ACS and stable CAD over patient lifetime. Pooled estimates for major clinical end points (all-cause mortality, myocardial infarction, stroke, rehospitalization, and revascularization) from relevant clinical trials were incorporated. Incremental benefit was quantified as quality-adjusted life-years (QALYs). Threshold analyses determined at what price difference high-dose statins would yield incremental cost-effective ratios below $50 000, $100 000, and $150 000 per QALY gained. In ACS patients, a high-dose versus conventional-dose statin strategy resulted in a gain of 0.35 QALYs. In threshold analyses, a high-dose statin strategy consistently yielded incremental cost-effective ratios below $30 000 per QALY even under conservative model assumptions. In stable CAD patients, a high-dose statin strategy yielded a gain of only 0.10 QALYs and was sensitive to model assumptions about statin efficacy. The daily cost difference between a high- and conventional-dose statin would need to be <$1.70, $2.65, and $3.55 to yield incremental cost-effective ratios below $50 000, $100 000, and $150 000 per QALY.

Conclusions--High-dose statin therapy is potentially highly effective and cost-effective in patients with ACS. In patients with stable CAD, however, the cost-effectiveness of high-dose statin therapy is highly sensitive to model assumptions about statin efficacy and cost. Use of high-dose statins can be supported on health economic grounds in patients with ACS, but the case is less clear for patients with stable CAD.

Key words: cholesterol • coronary disease • cost-benefit analysis • drugs • statins

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