An economic evaluation of rosuvastatin treatment in systolic heart failure: evidence from the CORONA trial

Paula K Lorgelly, Andrew H Briggs, Hans Wedel, Peter Dunselman, Ake Hjalmarson, John Kjekshus, Finn Waagstein, John Wikstrand, András Jánosi, Dirk J van Veldhuisen, Vivencio Barrios, Cândida Fonseca, John J V McMurray, CORONA Study Group, Peter Dunselman, Ake Hjalmarson, Lennart Janssonz, John Kjekshus, Magnus Lindberg, John J V McMurray, Finn Waagstein, Hans Wedel, John Wikstrand, Peter Dunselman, Ake Hjalmarson, John Kjekshus, John J V McMurray, Finn Waagstein, Hans Wedel, John Wikstrand, John Kjekshus, Peter Dunselman, Ake Hjalmarson, Eduard Apetrei, Michael Böhm, John G F Cleland, Jan H Corne, Assen Goudev, Peer Grande, Lars Gullestad, Jaromir Hradec, András Jánosi, Gabriel Kamensky, Michel Komajda, Jerzy Korewicki, Timo Kuusi, François Mach, Vyacheslav Mareev, Naresh Ranjith, Maria Schaufelberger, Johan Vanhaecke, Eduard Apetrei, Vivencio Barrios, Michael Böhm, John G F Cleland, Jan H Corne, Cândida Fonseca, Assen Goudev, Peer Grande, Lars Gullestad, John Wikstrand, András Jánosi, Gabriel Kamensky, Michel Komajda, Jerzy Korewicki, Timo Kuusi, François Mach, Vyacheslav Mareev, Naresh Ranjith, Maria Schaufelberger, Johan Vanhaecke, Dirk J van Veldhuisen, Henry Dargie, David DeMets, Rory Collins, Jan Feyz, Barry Massie, Bengt-Olov Fredlund, Mikael Holmberg, Katarina Saldeen, Ola Samuelsson, Karl Swedberg, Paula K Lorgelly, Andrew H Briggs, Hans Wedel, Peter Dunselman, Ake Hjalmarson, John Kjekshus, Finn Waagstein, John Wikstrand, András Jánosi, Dirk J van Veldhuisen, Vivencio Barrios, Cândida Fonseca, John J V McMurray, CORONA Study Group, Peter Dunselman, Ake Hjalmarson, Lennart Janssonz, John Kjekshus, Magnus Lindberg, John J V McMurray, Finn Waagstein, Hans Wedel, John Wikstrand, Peter Dunselman, Ake Hjalmarson, John Kjekshus, John J V McMurray, Finn Waagstein, Hans Wedel, John Wikstrand, John Kjekshus, Peter Dunselman, Ake Hjalmarson, Eduard Apetrei, Michael Böhm, John G F Cleland, Jan H Corne, Assen Goudev, Peer Grande, Lars Gullestad, Jaromir Hradec, András Jánosi, Gabriel Kamensky, Michel Komajda, Jerzy Korewicki, Timo Kuusi, François Mach, Vyacheslav Mareev, Naresh Ranjith, Maria Schaufelberger, Johan Vanhaecke, Eduard Apetrei, Vivencio Barrios, Michael Böhm, John G F Cleland, Jan H Corne, Cândida Fonseca, Assen Goudev, Peer Grande, Lars Gullestad, John Wikstrand, András Jánosi, Gabriel Kamensky, Michel Komajda, Jerzy Korewicki, Timo Kuusi, François Mach, Vyacheslav Mareev, Naresh Ranjith, Maria Schaufelberger, Johan Vanhaecke, Dirk J van Veldhuisen, Henry Dargie, David DeMets, Rory Collins, Jan Feyz, Barry Massie, Bengt-Olov Fredlund, Mikael Holmberg, Katarina Saldeen, Ola Samuelsson, Karl Swedberg

Abstract

Aims: To estimate the cost-effectiveness of 10 mg rosuvastatin daily for older patients with systolic heart failure in the Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA) trial.

Methods and results: This within trial analysis of CORONA used major cardiovascular (CV) events as the outcome measure. Resource use was valued and the costs of hospitalizations, procedures, and statin use compared. Cost-effectiveness was estimated as cost per major CV event avoided. There were significantly fewer major CV events in the rosuvastatin group compared with the placebo group (1.04 vs. 1.20 per patient; difference 0.164; 95% CI: 0.075-0.254, P < 0.001). The average cost of CV hospitalizations and procedures was significantly lower for those receiving rosuvastatin ( pound1531 vs. pound1769; difference pound238; 95% CI: pound73-403, P = 0.005); the additional cost of the statin resulted in significantly higher total costs for the rosuvastatin group ( pound1769 vs. pound2072; difference pound303; 95% CI: pound138-468, P < 0.001). Overall, rosuvastatin was found to cost pound1840 (95% CI: pound562-6028) per major CV event avoided.

Conclusion: This economic analysis showed that a significant reduction in major CV events with rosuvastatin led to significantly reduced costs of CV hospitalizations and procedures. The reduction in associated costs for major CV events was found to offset partially (by 44%) the cost of rosuvastatin treatment in patients with systolic heart failure.

Figures

Figure 1
Figure 1
Cost-effectiveness acceptability curves. aMaximum willingness to pay to avoid one major CV event.

References

    1. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, Witteman JC, Stricker BH. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J. 2004;25:1614–1619.
    1. Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D'Agostino RB, Kannel WB, Murabito JM, Vasan RS, Benjamin EJ, Levy D. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068–3072.
    1. Stewart S, MacIntyre K, Capewell S, McMurray JJ. Heart failure and the aging population: an increasing burden in the 21st century? Heart. 2003;89:49–53.
    1. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ. The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail. 2002;4:361–371.
    1. Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ. 2006;333:1145.
    1. Krum H, McMurray JJ. Statins and chronic heart failure: do we need a large-scale outcome trial? J Am Coll Cardiol. 2002;39:1567–1573.
    1. Kjekshus J, Dunselman P, Blideskog M, Eskilson C, Hjalmarson A, McMurray JV, Waagstein F, Wedel H, Wessman P, Wikstrand J. A statin in the treatment of heart failure? Controlled rosuvastatin multinational study in heart failure (CORONA): study design and baseline characteristics. Eur J Heart Fail. 2005;7:1059–1069.
    1. Kjekshus J, Apetrei E, Barrios V, Bohm M, Cleland JG, Cornel JH, Dunselman P, Fonseca C, Goudev A, Grande P, Gullestad L, Hjalmarson A, Hradec J, Jánosi A, Kamensky G, Komajda M, Korewicki J, Kuusi T, Mach F, Mareev V, McMurray JJ, Ranjith N, Schaufelberger M, Vanhaecke J, van Veldhuisen DJ, Waagstein F, Wedel H, Wikstrand J. Rosuvastatin in older patients with systolic heart failure. N Engl J Med. 2007;357:2248–2261.
    1. Department of Health. NHS reference costs 2005–06. .
    1. The NHS Information Centre. Casemix Service. .
    1. British Medical Association & Royal Pharmaceutical Society of Great Britain. British National Formulary. London: BMJ; 2006.
    1. Fieller EC. Some problems in interval estimation. J R Stat Soc Series B-Statist Methodol. 1954;16:175–185.
    1. van Hout BA, Al MJ, Gordon GS, Rutten FF. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;3:309–319.
    1. HM Treasury. The Green Book: Appraisal and Evaluation in Central Government. London: TSO; 2007.
    1. Healthcare Commission. Getting results: pathology services in acute and specialist trusts. .
    1. Netten A, Curtis L. Unit Costs of Health and Social Care 2006. Canterbury: Personal Social Services Research Unit, University of Kent; 2006.
    1. McMurray JJ, Andersson FL, Stewart S, Svensson K, Solal AC, Dietz R, Vanhaecke J, van Veldhuisen DJ, Ostergren J, Granger CB, Yusuf S, Pfeffer MA, Swedberg K. Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J. 2006;27:1447–1458.
    1. Reed SD, Anstrom KJ, Bakhai A, Briggs AH, Califf RM, Cohen DJ, Drummond MF, Glick HA, Gnanasakthy A, Hlatky MA, O'Brien BJ, Torti FM, Tsiatis AA, Willan AR, Mark DB, Schulman KA. Conducting economic evaluations alongside multinational clinical trials: toward a research consensus. Am Heart J. 2005;149:434–443.
    1. Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R. Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet. 2005;365:1779–1785.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72.
    1. Wedel H, McMurray JJ, Lindberg M, Wikstrand J, Cleland JG, Cornel JH, Dunselman P, Hjalmarson A, Kjekshus J, Komajda M, Kuusi T, Vanhaecke J, Waagstein F. Predictors of fatal and non-fatal outcomes in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): incremental value of apolipoprotein A-1, high-sensitivity C-reactive peptide and N-terminal pro B-type natriuretic peptide. Eur J Heart Fail. 2009;11:281–291.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться