Cost–effectiveness of adding ezetimibe to atorvastatin vs switching to rosuvastatin therapy in Portugal

Abstract

Background:

Statin monotherapy is the mainstay of low-density lipoprotein cholesterol (LDL-C) management for high cardiovascular risk patients in Portugal; however, several therapeutic options are available and predicted to have different clinical and economic impacts. The aim of this study was to evaluate the cost-effectiveness of adding ezetimibe 10?mg (EZ10) to atorvastatin 10 or 20?mg (A10/20) vs switching to rosuvastatin 10 or 20?mg (R10/20) in Portuguese patients with coronary heart disease (CHD) and/or diabetes who are currently above the LDL-C goal.     

Comparing the effectiveness of rosuvastatin and atorvastatin in preventing cardiovascular outcomes: estimates using the Archimedes model

Abstract

Objective:

This study used simulation to compare the effectiveness of rosuvastatin 20?mg vs atorvastatin 40?mg, and rosuvastatin 40?mg vs atorvastatin 80?mg in preventing MACE in a range of patient populations with varying baseline cardiovascular risk.

Research design and methods:

The Archimedes Model was used to simulate head-to-head clinical trials in nine patient populations: Framingham Risk Score (FRS)?≥?5%, 5–10%, 10–20%,?>?20%, EURO-SCORE?≥?5% and >10%, diagnosed diabetes, secondary prevention (history of myocardial infarction or stroke, CVD), and acute coronary syndrome (ACS). Simulated patients, aged 45–70 at trial start, were based on the NHANES 1999–2006. Treatments were modeled using results from the STELLAR, JUPITER, CARDS, ASCOT-LLA, and TNT trials. Treatment models were confirmed using trial validations.

Results:

Comparing rosuvastatin 20?mg vs atorvastatin 40?mg, the 5-year numbers needed to treat to prevent one MACE event (NNT) were 525, 70, and 55 for the FRS?≥?5%, CVD, and ACS groups, respectively. Comparing rosuvastatin 40?mg vs atorvastatin 80?mg the corresponding NNT values were 468, 63, and 51. The 20-year relative risks of MACE in the FRS?≥?5% population were 0.907 (0.901–0.913) for rosuvastatin 20?mg vs atorvastatin 40?mg and 0.892 (0.884–0.901) for rosuvastatin 40?mg vs atorvastatin 80?mg. The relative risks were similar for the remaining populations.

Conclusions:

This study found that rosuvastatin 20?mg and 40?mg lowers the risk of MACE more than atorvastatin 40?mg and atorvastatin 80?mg. While simulation models cannot replace real-world clinical trials, this study bridges gaps in the evidence, and identifies high risk cohorts that would likely see additional benefit from treatment with rosuvastatin rather than atorvastatin.