Skip to main content
SpringerLink
Log in

Cost-effectiveness of intensive atorvastatin therapy in secondary cardiovascular prevention in the United Kingdom, Spain, and Germany, based on the Treating to New Targets study

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

The Treating to New Targets (TNT) clinical trial found that intensive 80 mg atorvastatin (A80) treatment reduced cardiovascular events by 22% when compared to 10 mg atorvastatin (A10) treatment. We evaluated the cost-effectiveness of intensive A80 vs A10 treatment in the United Kingdom (UK), Spain, and Germany. A lifetime Markov model was developed to predict cardiovascular disease-related events, costs, survival, and quality-adjusted life-years (QALYs). Treatment-specific event probabilities were estimated from the TNT clinical trial. Post-event survival, health-related quality of life, and country-specific medical-care costs were estimated using published sources. Intensive treatment with A80 increased both the per-patient QALYs and corresponding costs of care, when compared to the A10 treatment, in all three countries. The incremental cost per QALY gained was € 9,500, € 21,000, and € 15,000 in the UK, Spain, and Germany, respectively. Intensive A80 treatment is estimated to be cost-effective when compared to A10 treatment in secondary cardiovascular prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Peterson, S., Peto, V., Rayner, M., Leal, J., Luengo-Fernandez, R., Gray, A.: European cardiovascular statistics. 2005 edition. European health network (2005). http://www.ehnheart.org/files/statistics%202005-092711A.pdf. Cited 28 June 2006

  2. Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study group. Lancet 344, 1383–1389 (1994)

    Google Scholar 

  3. Sachs, F.M., Pfeffer, M.A., Maye, L.A., et al.: Cholesterol and recurrent events trial investigators: the effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N. Engl. J. Med. 335, 1001–1009 (1996). doi:10.1056/NEJM199610033351401

    Article  Google Scholar 

  4. Shepherd, J., Cobbe, S.M., Ford, I., et al.: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N. Engl. J. Med. 333, 1301–1307 (1995). doi:10.1056/NEJM199511163332001

    Article  Google Scholar 

  5. Heart Protection Study Collaborative Group: MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360, 7–22 (2002). doi:10.1016/S0140-6736(02)09327-3

    Article  Google Scholar 

  6. Cannon, C.P., Braunwald, E., McCabe, C.H., et al.: Intensive vs. moderate lipid lowering with statins after acute coronary syndromes. N. Engl. J. Med. 350, 1495–1504 (2004). doi:10.1056/NEJMoa040583

    Article  Google Scholar 

  7. LaRosa, J.C., Grundy, S.M., Waters, D.D., Shear, C., Barter, P., Fruchart, J.C., et al.: Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N. Engl. J. Med. 352, 1425–1435 (2005). doi:10.1056/NEJMoa050461

    Article  Google Scholar 

  8. Waters, D.D., Guyton, J.R., Herrington, D.M., McGowan, M.P., Wenger, N., Shear, C.: TNT steering committee and investigators: treating to new targets (TNT) study: does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit? Am. J. Cardiol. 93, 154–158 (2004). doi:10.1016/j.amjcard.2003.09.031

    Article  Google Scholar 

  9. Gail, M., Simon, R.: Testing for qualitative interactions between treatment effects and patient subsets. Biometrics 41, 361–372 (1985). doi:10.2307/2530862

    Article  Google Scholar 

  10. Cook, J.R., Drummond, M., Glick, H., Heyse, J.F.: Assessing the appropriateness of combining economic data from multinational clinical trials. Stat. Med. 22, 1955–1976 (2003). doi:10.1002/sim.1389

    Article  Google Scholar 

  11. Pederson, T.R., Wilhelmsen, L., Færgeman, O., Timo, E., Strandberg, M.D., Thorgeirsson, G., Troedsson, L., Kristianson, J., Berg, K., Cook, T.J., Haghfelt, T., Kjekshus, J., Miettinen, T., Olsson, A.G., Pyörälä, K., Wedel, H.: Follow-up study of patients randomized in the Scandinavian Simvastatin Survival Study (4S) of cholesterol lowering. Am. J. Cardiol. 86, 257–262 (2000) (on behalf of the Scandinavian Simvastatin Survival Study group). doi:10.1016/S0002-9149(00)00910-3

    Google Scholar 

  12. Ford, I., Murray, H., Packard, C.J., et al.: Long-term follow-up of the West of Scotland coronary prevention study. N. Engl. J. Med. 357, 1477–1486 (2007). doi:10.1056/NEJMoa065994

    Article  Google Scholar 

  13. Rosengren, A., Spetz, C.L., Köster, M., Hammar, N., Alfredsson, L., Rosén, M.: Sex differences in survival after myocardial infarction. Eur. Heart. J. 22, 314–322 (2001). doi:10.1053/euhj.2000.2368

    Article  Google Scholar 

  14. Dennis, M.S., Burn, J.P.S., Sandercock, P.A.G., Bamford, J.M., Wade, D.T., Warlow, C.P.: Long-term survival after first-ever stroke: the Oxford shire community stroke project. Stroke 24, 796–800 (1993)

    Google Scholar 

  15. Blackledge, H.M., Tomlinson, J., Squire, I.B.: Prognosis for patients newly admitted to hospital with heart failure: survival trends in 12,220 index admissions in Leicestershire 1993–2001. Heart 89, 615–620 (2003). doi:10.1136/heart.89.6.615

    Article  Google Scholar 

  16. Pell, J.P., Walsh, D., Norrie, J., Berg, G., Colquhoun, A.D., Davidson, K., et al.: Outcomes following coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in the stent era: a prospective study of all 9,890 consecutive patients operated on in Scotland over a 2 year period. Heart 85, 662–666 (2001). doi:10.1136/heart.85.6.662

    Article  Google Scholar 

  17. Gwinnutt, C.L., Columb, M., Harris, R.: Outcome after cardiac arrest in adults in UK hospitals: effect of 1997 guidelines. Resuscitation 47(2), 125–135 (2000). doi:10.1016/S0300-9572(00)00212-4

    Article  Google Scholar 

  18. Government actuary department interim life tables UK 2002–2004. http://www.gad.gov.uk/Life_Tables/Historical_Interim_life_tables.htm. Cited 05 Jan 2006

  19. National Statistics Institute 2003 population projections. http://www.ine.es/inebase/. Cited 10 Feb 2006

  20. Lampe, F.C., Whincup, S.G., Wannamethee, A.G., Shaper, A.G., Walker, M., Ebrahim, S.: The natural history of prevalent ischaemic heart disease in middle-aged men. Eur. Heart. J. 21, 1052–1062 (2000). doi:10.1053/euhj.1999.1866

    Article  Google Scholar 

  21. Mosterd, A., Cost, B., Hoes, A.W., de Bruijne, M.C., Deckers, J.W., Hofman, A., et al.: The prognosis of heart failure in the general population the Rotterdam study. Eur. Heart. J. 22, 1318–1327 (2001). doi:10.1053/euhj.2000.2533

    Article  Google Scholar 

  22. Statistisches Bundesamt Perioden-Sterbetafeln fur Deutschland 2001/2003. http://www.destatis.de/download/d/bevoe/sterbet03xls. Cited 24 Feb 2006

  23. Office of National Statistics: mortality statistics, ONS 2004 population and death rates. http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=618&Pos=1&ColRank=1&Rank=272. Cited 05 Jan 2006

  24. National tables death statistics according to cause of death 2003. http://www.ine.es/inebase/. Cited 10 Feb 2006

  25. Federal health monitoring system deaths 2003. http://epp.eurostat.cec.eu.int. Cited 24 Feb 2006

  26. Sullivan, P.W., Lawrence, W.F., Ghushchyan, V.: A national catalog of preference-based scores for chronic conditions in the United States. Med. Care. 43, 736–749 (2005). doi:10.1097/01.mlr.0000172050.67085.4f

    Article  Google Scholar 

  27. Department of Health: national tariff costs 2005-2006. National Health Service, 2006. http://www.dh.gov.uk/assetRoot/04/09/15/31/04091531.pdf. Cited 05 Jan 2006

  28. National health service drug tariff for England and Wales: Part VIII—Basic prices of drugs. http://www.ppa.org.uk/edt/April_2006v3/mindex.htm. Cited 05 Jan 2006

  29. Gisbert, R., Brosa, M.: Base de datos de costes sanitarios. Versión 2.2. Soikos, Barcelona (2005)

    Google Scholar 

  30. Catálogo de especialidades farmacéuticas. Consejo General de Colegios Oficiales de Farmacéuticos, Madrid (2005)

  31. German diagnosis related groups: the official website the autonomy for German refined-diagnosis related groups. Final report for the advancement of the G-DRG-system for the year 2006. Report browser. http://www.g-drg.de/. Cited 19 May 2006

  32. Red List: 2005. Medication information for Germany. http://www.rote-liste.de/. Cited 10 Jun 2006

  33. Department of health: reference costs 2004. National health service. http://www.dh.gov.uk/assetRoot/04/10/55/53/04105553.xls. Cited 05 Jan 2006 (2004)

  34. Health and social care information centre (England): hospital episode statistics—2004/2005. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=204. Cited 05 Jan 2006

  35. Department for Education (2002) Employment, Labour and Social Affairs (DEELSA). Employment, Labour, and Social Affairs Committee. Summary of results from ischaemic heart disease study. http://www.olis.oecd.org/OLIS/2002DOC.NSF/43bb6130e5e86e5fc12569fa005d004c/71e60b595e9eca00c1256bdb003f4ae8/$FILE/JT00128391.PDF. Cited 05 May 2006

  36. National Institute for Clinical Excellence guide to the methods of technology appraisal. Draft for consultation (2003) http://www.nice.org.uk/page.aspx?o=205739. Cited 04 Jan 2006

  37. Efron, B., Tibshirani, R.J.: An introduction to the bootstrap. Chapman & Hall, New York (1993)

    Google Scholar 

  38. Tsevat, J., Kuntz, K.M., Orav, E.J., Weinstein, M.C., Sacks, F.M., Goldman, L.: Cost-effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels. Am. Heart. J. 141, 727–734 (2001). doi:10.1067/mhj.2001.114805

    Article  Google Scholar 

  39. Jönsson, B., Johannesson, M., Kjekshus, J., Olsson, A.G., Pedersen, T.R., Wedel, H.: Scandinavian survival study group: cost-effectiveness of cholesterol lowering. Results from the Scandinavian Simvastatin Survival Study (4S). Eur. Heart. J. 17, 1001–1007 (1996)

    Google Scholar 

  40. Pedersen, T.R., Faergeman, O., Kastelein, J.J.P., Olsson, A.G., Tikkanen, M.J., Holme, I., et al.: High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction the IDEAL study: a randomized controlled trial. JAMA 294, 2437–2445 (2005). doi:10.1001/jama.294.19.2437

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. i3 Innovus, 10 Cabot Road, Suite 304, Medford, MA, 02155, USA

    Douglas C. A. Taylor, Ankur Pandya, David Thompson, Paula Chu, Michael Drummond & Milton C. Weinstein

  2. Pfizer Inc., New York, NY, USA

    Jennifer Graff

  3. University of Glasgow, Glasgow, UK

    James Shepherd

  4. Emory University School of Medicine, Atlanta, GA, USA

    Nanette Wenger

  5. Hanseatisches Herzzentrum Hamburg, Hamburg, Germany

    Heiner Greten

  6. Universidad de Valencia, Valencia, Spain

    Rafael Carmena

  7. University of York, York, UK

    Michael Drummond

  8. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    Milton C. Weinstein

Authors
  1. Douglas C. A. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ankur Pandya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paula Chu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Graff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James Shepherd
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nanette Wenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heiner Greten
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rafael Carmena
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Milton C. Weinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas C. A. Taylor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, D.C.A., Pandya, A., Thompson, D. et al. Cost-effectiveness of intensive atorvastatin therapy in secondary cardiovascular prevention in the United Kingdom, Spain, and Germany, based on the Treating to New Targets study. Eur J Health Econ 10, 255–265 (2009). https://doi.org/10.1007/s10198-008-0126-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-008-0126-1

Keywords

JEL Classification

Search

Navigation