Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

Background: A recent Study Found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-close versus low-dose statin therapy. Objective: To examine the cost effectiveness of high-close versus low-dose statin therapy in CHIF patients. Methods: Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A 10) in patients with both CHF and coronary heart disease (CHID) [CHF/CHD], using a lifetime Markov model The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based oil clinical trial data. The quality of life and costs were literature based Measures Included costs per life-year saved (LYS) and QALY gained Health consequences and costs were discounted at 3 0% annually Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values. Results: Literature-based mortality estimates (base case) increased fife-years and QALYs For A80 compared with A10 (incremental cost-effectiveness ratios [ICERs] SUS9600 per LYS. SUS13600 per QALY) At a willingness to pay of SUS100 000 per QALY, A80 was cost effective in 80% of simulations. A10 dominated A80 when using trial-based mortality estimates (alternative scenario) At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations. Conclusions: Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US. due to projected gains in life expectancy and health-related quality of life However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A 10 dominates A80.