Abstract 3807: Cost-Effectiveness of High-dose Statin Therapy in High-Risk Patients with Coronary Artery Disease
Context: Recent clinical trials have found that high-dose statin therapy, when compared to conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). However, no single study demonstrated an impact on overall mortality and the cost-effectiveness of high-dose statin therapy is unknown.
Objective: To estimate the cost-effectiveness of high-dose statin therapy in patients with ACS and stable CAD.
Design, Setting, and Population: We used a simulation model to compare daily high-dose (atorvastatin 80mg) with conventional-dose (simvastatin 20mg) statin therapy for hypothetical 60 year-old cohorts with ACS and stable CAD. To inform the model, we incorporated pooled estimates for major clinical endpoints (all-cause mortality, myocardial infarction, stroke, rehospitalization, and revascularization) from four recent clinical trials (PROVE-IT, A to Z, IDEAL, and TNT).
Main Outcome Measures: Cost, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICERs).
Results: In ACS patients, a high-dose vs. conventional-dose statin strategy resulted in a gain of 1.19 QALYs and an ICER of $9,000 per QALY. In stable CAD patients, a high-dose statin strategy yielded a gain of only 0.10 QALYs and an ICER of $33,400 per QALY. The cost-effectiveness of a high-dose statin strategy was particularly sensitive to its projected efficacy beyond mean clinical trial follow-up periods and to statin cost. In ACS patients, a high-dose statin strategy remained cost-effective even when the cost of conventional-dose statins was negligible (ICER of $17,500 per QALY). In contrast, in patients with stable CAD, the daily cost difference between a high-dose and a conventional-dose statin would need to be less than $1.70, $2.65, and $3.55 to yield ICERs below $50,000, $100,000, and $150,000 per QALY.
Conclusion: High dose statin therapy is 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 statin cost.