Cost-Effectiveness of Managing Familial Hypercholesterolemia Using Atorvastatin-Based Preventive Therapy

Introduction and objectivesA cost-effectiveness model was developed to evaluate the efficiency of different preventive strategies in familial hypercholesterolemia (FH) in comparison with routine clinical practice (CP): atorvastatin monotherapy, 40 mg (A40) or 80 mg (A80), and atorvastatin combined with ezetimibe, 10 mg (A40+E10 or A80+E10).MethodsA longitudinal population model with a time horizon for life-expectancy was developed within the context of the Spanish public healthcare system. Life tables for the Spanish population (2002) were modified using the standardized mortality rate for individuals with FH. Effectiveness was expressed in life-years gained (LYG), after taking into account reductions for risk (ie, Framingham risk score) and cardiovascular mortality. The costs (in 2005 terms) of the intervention (Cl) and care (CC) were discounted at 6%, while effects were discounted at 3%.ResultsRoutine CP, based on the Spanish FH registry: 1.97 LYG per patient versus no treatment; Cl €5321, CC €23 389. A40: 2.59 LYG; reduction in CC compared with CP 4.5%; total costs (TC) €30 569. A80: 2.75 LYG; reduction in CC 6.4%; TC €30 133. A40+E10: 3.38 LYG; reduction in CC 14.3%; TC €36 104. A80+E10: 3.62 LYG; reduction in CC 17.6%; TC €35 317. From most to least efficient strategy, the incremental cost-effectiveness per LYG compared with CP was: a) A80: €1821; b) A40: €3012; c) A80+E10: €4021; and d) A40+E10:€5250.ConclusionsPreventive treatment of FH with atorvastatin was cost-effective. The greatest cost-effectiveness was obtained with atorvastatin monotherapy, 80 mg. The addition of ezetimibe could produce further benefits at an acceptable incremental cost.

Introducción y objetivosEvaluar la eficiencia de distintas estrategias preventivas en hipercolesterolemia familiar (HF) mediante un modelo de coste-efectividad de atorvastatina 40 mg y 80 mg en monoterapia (A40, A80) o combinado con ezetimiba 10 mg (A40+E10, A80+E10) respecto a la práctica clínica (PC).MétodosModelo poblacional longitudinal, horizonte temporal: esperanza de vida. Perspectiva del SNS. Las tablas de vida de población española (2002) se modificaron con la tasa de mortalidad estandarizada (TME) para la población con HF. La eficacia se transformó, al disminuir el riesgo (tablas de riesgo de Framingham) y aminorar la mortalidad cardiovascular en años de vida ganados (AVG). Los costes (de 2005) de intervención (Cl) y los costes de manejo (CM) se descontaron al 6% y los efectos, al 3%.ResultadosEn PC, según el Registro Español de HF: 1,97 AVG por paciente respecto a no tratar; Cl, 5.321 euros, y otros CM, 23.389 euros. A40: 2,59 AVG, reducción del 4,5% del CM sobre PC, y coste total (COT), 30.569 euros. A80: 2,75 AVG, reducción del 6,4% del CM, y COT, 30.133 euros. A40+E10: 3,38 AVG, CM de 14,3% y COT, 36.104 euros. A80+E10: 3,62 AVG, reducción del 17,6% de CM y COT, 35.317 euros. De más a menos eficiente, el coste-efectividad incremental (CEI) por AVG extra respecto a PC: a) A80: 1.821 euros; b) A40: 3.012 euros; c) A80+E10: 4.021 euros, y d) A40+E10: 5.250 euros.ConclusionesEl manejo preventivo de los pacientes con HF con atorvastatina es eficiente. La máxima eficiencia se consigue con atorvastatina 80 mg en monoterapia. Añadir ezetimiba puede producir un efecto adicional a un coste incremental aceptable.