Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events

Abstract

Background: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.

Methods: A PROBABILISTIC MONTE CARLO SIMULATION MODEL BASED ON DATA FROM JUPITER (THE JUSTIFICATION FOR THE USE OF STATINS IN PREVENTION: an Intervention Trial Evaluating Rosuvastatin) was used to estimate the long-term cost-effectiveness of rosuvastatin 20 mg daily versus simvastatin or atorvastatin 40 mg for the prevention of cardiovascular death and morbidity. The three- stage model included cardiovascular event prevention simulating the 4 years of JUPITER, initial prevention beyond the trial, and subsequent cardiovascular event prevention. A Swedish health care payer perspective (direct costs only) was modeled for a lifetime horizon, with 2008/2009 as the costing period. Univariate and probabilistic sensitivity analyses were performed.

Results: The incremental cost per quality-adjusted life-year (QALY) gained with rosuvastatin 20 mg over simvastatin or atorvastatin 40 mg ranged from SEK88,113 (rosuvastatin 20 mg versus simvastatin 40 mg; Framingham risk ≥30%; net avoidance of 34 events/1000 patients) to SEK497,542 (versus atorvastatin 40 mg: Framingham risk ≥20%; net avoidance of 11 events/1000 patients) over a lifetime horizon. Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%-85% of simulations relative to atorvastatin or simvastatin 40 mg. Sensitivity analyses indicated the findings to be robust.

Conclusion: Rosuvastatin 20 mg is cost-effective over a lifetime horizon compared with generic simvastatin or atorvastatin 40 mg in patients at high cardiovascular risk in Sweden.

Keywords: atorvastatin; cardiovascular disease; cost-benefit analysis; cost-effectiveness; generic; high risk; rosuvastatin; simvastatin.

Figure 1

Model structure overview. Abbreviations: CVD, cardiovascular disease; RCT, randomized controlled trial.

Figure 2

Model cohort simulation. Abbreviations: ICER, incremental cost effectiveness ratio; LYs, life-years; QALYs, quality-adjusted life-years; Tx, treatment.

Figure 3

(A) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus atorvastatin 40 mg assuming a 95% generic price reduction from brand. (B) One-way sensitivity analysis of lifetime horizon for Framingham 20% risk population (JUPITER population): rosuvastatin 20 mg versus simvastatin 40 mg assuming a 95% generic price reduction from brand. Abbreviations: CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; Tx, treatment; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; RR, relative risk; QALY, quality adjusted life-year.

Figure 4

(A) Willingness to pay-cost/QALY ICER with a lifetime horizon for Framingham 20% risk population (JUPITER population) rosuvastatin 20 mg versus atorvastatin 40 mg, assuming a generic 95% price reduction from brand. (B) Willingness to pay-cost/QALY ICER with a lifetime horizon for Framingham 20% risk population (JUPITER population) rosuvastatin 20 mg versus simvastatin 40 mg, generic 95% price reduction from brand. Abbreviations: QALY, quality adjusted life year; ICER, incremental cost-effectiveness ratio; SEK, Swedish kronor; JUPITER, the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin.