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Cost-effectiveness analysis of using high doses of atorvastatin for the secondary stroke prevention in Spain

A. Arrospide, J. Mar, J. Vivancos, J. Rejas-Gutiérrez, J. Caro [REV NEUROL 2010;51:1-11] PMID: 20568062 DOI: https://doi.org/10.33588/rn.5101.2009604

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Volumen 51 | Number 01 | Nº of views of the article 5.738 | Nº of PDF downloads 1.244 | Article publication date 01/07/2010

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ABSTRACT

AIM To estimate the cost-effectiveness of atorvastatin at high doses (80 mg/day) for the reduction of the risk of fatal and nonfatal stroke in patients with recent cerebrovascular accident or transient ischemic attack (TIA) and without coronary heart disease in Spain using data from the SPARCL study.

PATIENTS AND METHODS A discrete event simulation was developed to represent the natural evolution of a cohort of 1000 patients following a stroke or TIA. The risk for fatal and non fatal cardiovascular events was calculated from the clinical characteristic of patients in the SPARCL study for both treatment arms (atorvastatin 80 mg/day and placebo). Survival time, quality-adjusted-life-years (QALY), clinical events, and medical direct costs for a period of 5 years with a 3% per year discount were calculated for the two alternatives. A probabilistic sensitivity analysis was made running 1000 simulations.

RESULTS Compared to placebo, atorvastatin 80 mg/day prevented 22 strokes (14 nonfatal and 8 fatal), 22 myocardial infarctions (19 nonfatal and 3 fatal), 33 TIAs, 8 unstable angina episodes and 37 re-vascularisations per 1000 patients over 5 years. The incremental cost effectiveness ratio after 1000 simulations was 9914 € (95% CI = 5717 to 26 082) per QALY. The acceptability curve showed 99% of the simulations falling below an acceptability threshold of 30 000€/QALY.

CONCLUSIONS Compared with placebo, use of high dose atorvastatin (80 mg/day) for secondary stroke prevention is not only of significant clinical benefit but can also be considered cost effective in Spain. It produces important benefits in health with an incremental cost within reasonable limits. KeywordsAtorvastatin Cardiovascular risk Cerebrovascular disease Cost-effectiveness Statins Stroke Transient ischemic attack CategoriesPatología vascular

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Original

Cost-effectiveness analysis of using high doses of atorvastatin for the secondary stroke prevention in Spain