Population-based health-economic evaluation of the secondary prevention of coronary heart disease in Finland

Objective: To evaluate the cost-effectiveness of generic atorvastatin 20 mg (A20), branded rosuvastatin 10 mg (R10), generic simvastatin 40 mg (S40) and the combination of generic S40+branded ezetimibe 10 mg (S40+EZ10) for the secondary prevention of coronary heart disease (CHD) in Finnish patients not meeting the target goal of low-density lipoprotein cholesterol (LDL-C) with S40. Research design and methods: A probabilistic Markov model was employed to evaluate the costs and health outcomes of the different therapies based on the cardiovascular events avoided. The model included Framingham risk equations, Finnish population characteristics, event rates, quality of life estimates, resource use and unit costs. The LDL-C lowering efficacies were gathered from a systematic literature review, based on a search of Medline carried out in June 2008 (no time limit). Main outcome measures: Incremental cost per quality-adjusted life year (QALY) gained and incremental cost per life year gained (LYG). Results: The efficacy (LDL-C decrease) gained from switching S40 to S40+EZ10 was consistent in the literature review, whereas the LDL-C decrease gained from switching S40 to A20/R10 was uncertain. The incremental cost per QALY gained from switching generic S40 was lowest for S40+EZ10 ((sic)22,841 [(sic)24,017] and (sic)26,595 [(sic)46,686] for diabetic and non-diabetic men [women], respectively). The respective incremental cost per QALY gained for S40+EZ10 vs. A20 were (sic)19,738 ((sic)21,405) and (sic)23,596 ((sic)40,087). A20 dominated R10. Based on the cost-effectiveness acceptability frontier with a willingness-to-pay value of (sic)30,000 per QALY gained, the probability of cost-effectiveness for switching generic S40 to S40+EZ10 was 100% for men and diabetic women. Sensitivity analyses showed that results were robust. Conclusions: In the Finnish secondary prevention population that is not at goal on S40, switching generic S40 to S40+EZ10 is more cost-effective than switching S40 to generic A20 or R10.