BackgroundStatins have proven efficacy in the reduction of cardiovascular events, but the
financial impact of its widespread use can be substantial.ObjectiveTo conduct a cost-effectiveness analysis of three statin dosing schemes in the
Brazilian Unified National Health System (SUS) perspective.MethodsWe developed a Markov model to evaluate the incremental cost-effectiveness ratios
(ICERs) of low, intermediate and high intensity dose regimens in secondary and
four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of
cardiovascular events. Regimens with expected low-density lipoprotein cholesterol
reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between
30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40%
(atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data
were obtained from a systematic review with 136,000 patients. National data were
used to estimate utilities and costs (expressed as International Dollars - Int$).
A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product
per capita (circa Int$11,770) was applied.ResultsLow dose was dominated by extension in the primary prevention scenarios. In the
five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The
ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY
in all scenarios. In the cost-effectiveness acceptability curves, intermediate
dose had a probability above 50% of being cost-effective with ICERs between Int$
9,000-20,000 per QALY in all scenarios.ConclusionsConsidering a reasonable WTP threshold, intermediate dose statin therapy is
economically attractive, and should be a priority intervention in prevention of
cardiovascular events in Brazil.