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PHARMACOECONOMICS

Cost-Effectiveness of Fluvastatin Following Successful First Percutaneous Coronary Intervention

Senior Research Consultant, Policy Analysis Inc. (PAI), Brookline, MA

Terry A Jacobson, MD

Director, Office of Health Promotion and Disease Prevention, Department of Medicine, Emory University, Atlanta, GA

Patrick WJC Serruys, MD PhD

Director, Interventional Cardiology, Thoraxcenter, Academic Hospital Rotterdam, Netherlands

John S Edelsberg, MD MPH

Medical Director, Policy Analysis Inc. (PAI)

Gerry Oster, PhD

Vice President, Policy Analysis Inc. (PAI)

Reprints: Mr. Delea, Policy Analysis Inc. (PAI), Four Davis Ct., Brookline, MA 02245-7629, fax 617/232-1155, tdelea{at}pai2.com

BACKGROUND: In the LIPS (Lescol Intervention Prevention Study), fluvastatin 80 mg/day reduced the risk of major adverse cardiac events (MACE) by 22% versus placebo (p = 0.01) following successful first percutaneous coronary intervention (PCI) in patients with stable or unstable angina or silent ischemia. The cost-effectiveness of such therapy is unknown.

OBJECTIVE: To evaluate the cost-effectiveness of fluvastatin following successful first PCI from a US healthcare system perspective.

METHODS: We used a Markov model to estimate expected outcomes and costs of 2 alternative treatment strategies following successful first PCI in patients with stable or unstable angina or silent ischemia: (1) diet/lifestyle counseling plus immediate fluvastatin 80 mg/day; and (2) diet/lifestyle counseling only, with initiation of fluvastatin 80 mg/day following occurrence of future nonfatal MACE. The model was estimated with data from LIPS and other published sources. Cost-effectiveness was calculated as the ratio of the difference in expected medical-care costs to the expected difference in life-years (LYs) and quality-adjusted life-years (QALYs) alternatively.

RESULTS: Treatment with fluvastatin following successful first PCI was found to increase life expectancy by 0.78 years (QALYs 0.68). Cost-effectiveness of fluvastatin following successful first PCI is $13 505 per LY ($15 454 per QALY) saved. Ratios are lower for patients with diabetes ($9396 per LY; $10 718 per QALY) and those with multivessel disease ($9662 per LY; $11 076 per QALY). Findings were robust with respect to changes in key model parameters and assumptions.

CONCLUSIONS: Fluvastatin therapy following PCI is cost-effective compared with other generally accepted medical interventions.

Key Words: angioplasty, coronary disease, cost–benefit analysis, hypercholesterolemia

Published Online, March 1, 2005. www.theannals.com, DOI 10.1345/aph.1E367

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