Inpharma 1665 - 22 Nov 2008

CVD news from ISPORAthens, Greece November 2008

The following article highlights a selection of studies embedded in the model showed that, at a 12% event riskevaluating the costs and outcomes associated with the during the first 6 months and a 4% risk during latertreatment and prevention of cardiovascular disorders months, and an estimated 10% additional efficacy for(CVD), presented at the 11th Annual European high-dose versus medium-dose atorvastatin, theConference of the International Society for estimated number needed to treat to avoid one eventPharmacoeconomics and Outcomes Research (ISPOR), would be about 50. Costs per life-year gained and perheld in Athens, Greece, in November. QALY gained were estimated at below £10 000 for

high-dose versus medium-dose atorvastatin.Statin + niacin improves costs The investigators reiterate that their analysis isA comprehensive treatment approach involving a preliminary, and that the results may alter followingcombination of a statin and extended-release niacin can reconsideration of the priors. In addition, "subsequentimprove lipid values and lead to lower total medical probabilistic analysis will be used to explore uncertaintiescosts, say researchers from the US.1around the estimates", they contend.Clinical and economic data for the 12 months prior toIrbesartan good value in Greeceand after initiation of combination therapy were

evaluated for a retrospective cohort of 845 patients An analysis carried out in Greece concluded that, for(mean age 52.6 years) with primary or secondary risk for different patient populations, irbesartan "representsCVD. The mean changes in lipid values for LDL- good value for money in the Greek NHS setting",cholesterol, HDL-cholesterol and triglycerides were compared with commonly used alternatives.4

–10.81 mg/dL, +2.73 mg/dL and – 22.67 mg/dL, A Markov model was constructed to evaluaterespectively. irbesartan in relation to losartan and valsartan in the

Multivariate analysis revealed an increased likelihood treatment of hypertension – a major risk factor for CVDof goal attainment for LDL-cholesterol (OR 1.56), HDL- – in Greece. For the baseline cohort with mild-to-cholesterol (1.58) and triglycerides (1.39) after initiation moderate disease (age 57 years, systolic BP 147mm Hg,of statin and niacin therapy. Moreover, GEE results cholesterol 6.00 mmol/L, BMI 29 kg/m2), irbesartandemonstrated significant improvements from pre-index would be associated with 12.67 QALYs, and a total costin both annual CVD attributable inpatient visits (17 vs 9 of €15 146, compared with 12.63 QALYs and €15 486per 100 patients; p < 0.0001) and total medical cost for losartan, and 12.64 QALYs and €15 613 for($US3214 vs $US2039; p < 0.0001). valsartan. In patients with severe hypertension,

irbesartan would be both more effective and less costlySimvastatin + niacin pays off for health plan than the other two medications, resulting in economicAnother US study found that the addition of extended- dominance.release niacin and simvastatin therapy to a health planAmlodipine/atorvastatin worth it in Koreaformulary increased individual and combined optimal

lipid value "thereby having the potential to reduce the Single pill amlodipine/atorvastatin "represents a cost-incidence of CV events and CV-related medical costs".2 effective strategy for the primary prevention of CVD in

Using data for primary and secondary risk patients Korea", according to researchers from Australia andabstracted from the Health-Core Integrated Research South Korea.5

Database, the researchers modelled the effect of two Their Markov model was designed to assess the costhypothetical formularies (one with fixed-dose, effectiveness of a single pill combination of amlodipine/extended-release niacin and simvastatin, and one atorvastatin for the primary prevention of CVD among awithout) on costs and outcomes over a 3-year period. cohort of 171 adults aged ≥ 55 years who were CVD-The results showed that a revised formulary (containing free but met current Korean criteria for treatment withextended-release niacin and simvastatin) would increase the combination therapy. Follow-up was simulated foroptimal lipid value attainment by 0.57% over 3 years, 40 years. The model showed that, compared with nocompared with the current formulary. treatment, single pill amlodipine/atorvastatin would

The cost for a 1% increase in optimal LDL-cholesterol, have an incremental cost-effectiveness ratio of aboutHDL-cholesterol, and triglyceride attainment was W1.4 million* per QALY gained, and about W1.9 millionestimated at $US3103, $US952 and $US2047, per year of life saved. Sensitivity analysis "indicated theserespectively. There would be an estimated cost of results to be robust", the researchers note.$US1147 for every 1% increase in combined optimal High-dose atorvastatin IDEAL in Spainlipid value attainment with the revised versus current Even in a low-cost generics market, "high doseformulary. atorvastatin is a good option compared to standardHigh-dose atorvastatin wins out in the UK therapy with simvastatin", say researchers from Spain

High-dose atorvastatin (80mg) is likely to be more and the UK.6

cost effective than medium-dose atorvastatin (40mg) in The IDEAL trial (Incremental Decrease in End Pointspatients with acute coronary syndrome, suggests a through Aggressive Lipid Lowering) involved 8888study conducted by investigators from the UK.3 patients with a history of acute MI who were

They built a Markov model using efficacy results randomised to receive atorvastatin 80mg or simvastatinbased on a preliminary Bayesian meta-analysis linking a 20–40mg; median follow-up was 4.8 years. A within trialdecrease in LDL-cholesterol levels to decreases in pharmacoeconomic analysis was developed to estimatesecondary cardiac events (MI, stroke, cardiovascular the cost per event avoided. Direct and indirect costsdeath), drawing data from the A to Z and PROVE-IT trials were included in the model.and using priors from other statin trials. UK cost data After 4.8 years, treatment with intensive atorvastatin

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Inpharma 22 Nov 2008 No. 16651173-8324/10/1665-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

of optimal lipid value attainment. 11th Annual European Congress of thecould avoid one in six CV events, compared withInternational Society for Pharmacoeconomics and Outcomes Research : 406moderate simvastatin therapy among patients with abstr. PCV81, 8 Nov 2008.

3. Thurston SJ, et al. Cost effectiveness of high dose atorvastatin in acute coronarycongestive heart disease. Although atorvastatin has asyndrome patients in the UK. 11th Annual European Congress of thehigher acquisition cost than simvastatin, this cost wasInternational Society for Pharmacoeconomics and Outcomes Research : 405

offset by reduced hospitalisations and work days lost for abstr. PCV77, 8 Nov 2008.4. Maniadakis N, et al. Economic evaluation of irbesartan in Greece. 11th Annualatorvastatin recipients. Using Spanish costs, the

European Congress of the International Society for Pharmacoeconomics andincremental cost for atorvastatin to avoid one event Outcomes Research : 405-406 abstr. PCV79, 8 Nov 2008.(versus simvastatin) would be €15 168. 5. Liew D, et al. Single pill amlodipine/atorvastatin is cost-effective for the

primary prevention of cardiovascular disease in Korea. 11th Annual European* Korean Won (W1000 = approximately $US1) Congress of the International Society for Pharmacoeconomics and Outcomes

Research : 396-397 abstr. PCV51, 8 Nov 2008.1. Simko RJ, et al. Change in lipid values, target lipid value attainment, and annual 6. Sanchez Maestre C, et al. Cost-effectiveness of atorvastatin 80 mg vs generic

health care resource utilization and costs among patients initiating combination simvastatin 20 to 40 mg in secondary prevention in Spain. 11th Annualstatin and extended-release niacin therapy. 11th Annual European Congress of European Congress of the International Society for Pharmacoeconomics andthe International Society for Pharmacoeconomics and Outcomes Research : Outcomes Research : 396 abstr. PCV49, 8 Nov 2008.406-407 abstr. PCV82, 8 Nov 2008.

8010999492. Balu S, et al. An economic evaluation of the addition of fixed-dose niacin

extended-release and simvastatin therapy to the managed care formulary in terms

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