STATIN’S COST- EFFECTIVENESS: A CANADIAN ANALYSIS OF COMMONLY PRESCRIBED GENERIC AND BRAND NAME STATINS
Main Article Content
Keywords
Statin, cost-effectiveness, generic, cardiovascular disease, cholesterol
Abstract
Background
Generic statins may be considered as a compelling treatment option for managing dyslipidemia, due to
their reduced cost, compared to their brand name equivalent. However, further assessment is needed to determine whether using a particular generic statin is more cost-effective relative to other brand-name statins.
Objective
The purpose of this study is to compare the cost-effectiveness of the most commonly prescribed statins in Canada with respect to 1) lowering low-density lipoprotein cholesterol level (LDL -C) and 2) achieving National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) LDL-C goal.
Methods
The study was conducted from the perspective of Canadian payers over a 1-year time horizon. Clinical
data were obtained from the STELLAR trial (n=2268) in which patients received fixed doses of rosuvastatin, atorvastatin, simvastatin and pravastatin. Brand and generic drug costs were based on wholesale acquisition costs. Relative cost-effectiveness was assessed using the net monetary benefit approach (NMB), which allows probabilistic cost-effectiveness comparison of the various treatment options over a wide range of willingness-to-pay (WTP) values for a unit of clinical effect.
Results
Rosuvastatin 10mg was the most cost-effective statin over the largest range of WTP values. Pravastatin
10mg was cost-effective when the clinical outcomes had little or no monetary value. Rosuvastatin 20mg was more cost-effective at the highest end of the WTP spectrum.
Conclusion
The result of this analysis provides evidence that prescribing generic statins in Canada does not
necessarily translate into the most cost-effective option for treating dyslipidemia; especially as the monetary value of 1% decrease in LDL-C or patients achieving NCEP ATP III target increases.
References
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13. Baigent C, Keech A, Kearney PM, et al; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol- lowering treatment: prospective meta -analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005 Oct 8;366(9493):1267 -78.
14. Pilote L, Ho V, Lavoie F, Coupal L, Zowall H, Grover SA. Cost-effectiveness of lipid-lowering treatment according to lipid level. Can J Cardiol 2005 Jun;21(8):681-7.
15. Grover SA, Ho V, Lavoie F, Coupal L, Zowall H, Pilote L. The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins? Arch Intern Med 2003 Feb 10;163(3):333-9.
16. Spaans JN, Coyle D, Fodor G, et al. Application of the 1998 Canadian cholesterol guidelines to a military population: health benefits and cost effectiveness of improved cholesterol management. Can J Cardiol 2003 Jun;19(7):790-6.
17. Russell MW, Huse DM, Miller JD, Kraemer DF, Hartz SC. Cost effectiveness of HMG-CoA reductase inhibition in Canada. Can J Clin
Pharmacol 2001 Spring;8(1):9-16.
18. Perreault S, Levinton C, Le Lorier J. Efficacy and cost of HMG-CoA reductase inhibitors in the treatment of patients with primary hyperlipidemia. Can J Clin Pharmacol 2000 Autumn;7(3):144-54.
19. Grover SA, C oupal L, Paquet S, Zowall H. Cost- effectiveness of 3-hydroxy-3- methylglutaryl-coenzyme A reductase inhibitors in the secondary prevention of cardiovascular disease:forecasting the incremental benefits of preventing coronary and cerebrovascular events. Arch Intern Med 1999 Mar 22;159(6):593-600.
20. Perreault S, Hamilton VH, Lavoie F, Grover S. Treating hyperlipidemia for the primary prevention of coronary disease. Are higher dosages of lovastatin cost-effective? Arch Intern Med 1998 Feb 23;158(4):375-81.
21. Otten N. A Canadian perspective. Value Health 1998 Nov;1(4):218-23.
22. MacNeil P. Economic aspects of hypercholesterolemia treatment with HMG-CoA reductase inhibitors: a review of recent developments. Can J Cardiol 1998 Apr;14 Suppl A:14A-16A.
23. Riviere M, Wang S, Leclerc C, Fitzsimon C, Tretiak R. Cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease in Canada. CMAJ 1997 Apr 1;156(7):991-7.
24. Perreault S, Hamilton VH, Lavoie F, Grover S. A head- to- head comparison of the cost effectiveness of HMG- CoA reductase inhibitors and fibrates in different types of primary hyperlipidemia. Cardiovasc Drugs Ther 1997 Jan;10(6):787-94 .
25. Hamilton VH, Racicot FE, Zowall H, Coupal L, Grover SA. The cost-effectiveness of HMG- CoA reductase inhibitors to prevent coronary heart disease. Estimating the benefits of increasing HDL-C. JAMA 1995 Apr 5;273(13):1032 -8.
26. Martens LL, Guibert R. Cost-effectiveness analysis of lipid-modifying therapy in Canada: comparison of HMG- CoA reductase inhibitors in the primary prevention of coronary heart disease. Clin Ther 1994 Nov- Dec;16(6):1052-62; discussion 1036.
27. Adis Editors. Generics take off in France, 2006. PharmacoEconomics and Outcomes News;506. p.1.
28. NCEP Expert Panel. Third Report of National Cholesterol Education Program (NCER) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final Report. Circulation 2002;106:3143-3421.
29. Guyton JR. Benefit versus risk in statin treatment. Am J Cardiol 2006 Apr 17;97(8A):95C-97C.
30. Goettsch WG, Heintjes EM, Kastelein JJ, Rabelink TJ, Johansson S, Herings RM. Results from a rosuvastatin historical cohort study in more than 45,000 Dutch statin users, a PHARMO study. Pharmacoepidemiol Drug Saf 2006 Jul;15(7):435-43.
31. McAfee A, Ming E, Seeger J, et al. The comparative safety of rosuvastatin: a retrospective matched cohort study in over 48,000 initiators of statin therapy. Pharmacoepidemiol Drug Saf 2006 Jul;15(7):444-53.
32. Miller PS, Smith DG, Jones P. Cost effectiveness of rosuvastatin in treating patients to low-density lipoprotein cholesterol goals compared with atorvastatin, pravastatin, and simvastatin (a US Analysis of the STELLAR Trial).Am J Cardiol 2005 Jun 1;95(11):1314- 9.
33. Briggs AH, Gray AM. Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess
1999;3(2):1 -134.
34. Brown WV, Bays HE, Hassman DR, et al. Rosuvastatin Study Group. Efficacy and safety of rosuvastatin compared with pravastatin and simvastatin in patients with hypercholesterolemia: a randomized, double-blind, 52-week trial. Am Heart J 2002 Dec;144(6):1036 -43.
35. Olsson AG, Istad H, Luurila O, et al. Rosuvastatin Investigators Group. Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia. Am Heart J 2002 Dec;144(6):1044 -51.
36. Dart A, Jerums G, Nicholson G, et al. A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin
versus simvastatin in patients with hypercholesterolemia. Am J Cardiol 1997 Jul 1;80(1):39-44.
37. Davidson M, Ma P, Stein EA, et al. Comparison of effects on low-density lipoprotein cholesterol and high- density lipoprotein cholesterol with rosuvastatin versus atorvastatin in patients with type IIa or IIb hypercholesterolemia. Am J Cardiol 2002 Feb 1;89(3):268- 75.
38. Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making 1998 Apr-Jun;18(2 Suppl):S68- 80.
39. Weinstein MC. From cost-effectiveness ratios to resource allocation: where to draw the line? In: Sloan FA, ed. Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies. New York: Cambridge University Press, 1995:77-96.
40. PPS Pharma. PPS Pharma Buyers Guide. Moncton: Total Pricing System Inc., January 2006.
41. Brogan. Brogan iMAM. (June 1, 2006) http://www.broganinc.com/ (June 1, 2006).
42. Jones PH, Davidson MH, Stein EA, et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus
atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol 2003 jul 15;92(2):152-60.
43. Anonymous. A switch in time saves more than nine. Two popular statins, Pravachol and Zocor, go generic this summer, paving the way for
significant savings. Harv Heart Lett 2006 May;16(9):1-2.
44. Moon JC, Bogle RG. Switching statins. BMJ 2006 Jun 10;332(7554):1344-5.
45. Canadian Pharmacists Association: Compendium of Pharmaceuticals and Specialties. Ottawa: Canadian Pharmacists Association, 2006.
46. Bullano MF, Wertz DA, Yang GW, et al. Effect of rosuvastatin compared with other statins on lipid levels and national cholesterol education program goal attainment for low- density lipoprotein cholesterol in a usual care setting. Pharmacotherapy 2006 Apr;26(4):469- 78.
47. Nissen SE, Nicholls SJ, Sipahi I, et al. ASTEROID Investigators. Effect of very high- intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006 Apr 5;295(13):1556- 65.
48. Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol 2006 Apr 17;97(8A):27C-31C.
49. Koro CE, Bowlin SJ, Stump TE, Sprecher DL, Tierney WM. The independent correlation between high-density lipoprotein cholesterol and subsequent major adverse coronary events. Am Heart J 2006 Mar;151(3):755.e1-e6.
50. Wei L, Murphy MJ, MacDonald TM. Impact on cardiovascular events of increasing high density lipoprotein cholesterol with and without lipid lowering drugs. Heart 2006 Jun;92(6):746-51.
2. Choi BK, Pak AW. A method for comparing and combining cost-of-illness studies: an example from cardiovascular disease. Chronic Dis Can 2002 Spring;23(2):47-57.
3. Heart and Stroke Foundation of Canada. The Growing Burden of Heart Disease and Stroke in Canada 2003.Ottawa: Heart and Stroke Foundation of Canada, 2003.
4. Genest J, Frohlich J, Fodor G, McPherson R; Working Group on Hypercholesterolemia and Other Dyslipidemias. Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update. CMAJ 2003 Oct 28;169(9):921-4.
5. Grundy SM. United States Cholesterol Guidelines 2001: expanded scope of intensive low- density lipoprotein-lowering therapy. Am J Cardiol 2001 Oct 11;88(7B):23J-27J.
6. The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383 –9.
7. Shepherd J, Cobbe SM, Ford I, et al. for the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease in men with hypercholesterolemia. N Engl J Med 1995;333:1301–7.
8. Sacks FM, Pfeffer MA, Moye LA, et al. for the 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 1996;335:1001–9.
9. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998;339:1349–57.
10. Downs JR, Clearfield M, Weis S, et al. for the AFCAPS/TexCAPS Research Group. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998;279:1615–22.
11. Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high- risk individuals: a randomized placebo -controlled trial. Lancet 2002;360:7 –22.
12. Serruys PW, de Feyter P, Macaya C, et al. Fluv astatin for prevention of cardiac events following successful first percutaneous coronary intervention. JAMA 2002;287:3215–22.
13. Baigent C, Keech A, Kearney PM, et al; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol- lowering treatment: prospective meta -analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005 Oct 8;366(9493):1267 -78.
14. Pilote L, Ho V, Lavoie F, Coupal L, Zowall H, Grover SA. Cost-effectiveness of lipid-lowering treatment according to lipid level. Can J Cardiol 2005 Jun;21(8):681-7.
15. Grover SA, Ho V, Lavoie F, Coupal L, Zowall H, Pilote L. The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins? Arch Intern Med 2003 Feb 10;163(3):333-9.
16. Spaans JN, Coyle D, Fodor G, et al. Application of the 1998 Canadian cholesterol guidelines to a military population: health benefits and cost effectiveness of improved cholesterol management. Can J Cardiol 2003 Jun;19(7):790-6.
17. Russell MW, Huse DM, Miller JD, Kraemer DF, Hartz SC. Cost effectiveness of HMG-CoA reductase inhibition in Canada. Can J Clin
Pharmacol 2001 Spring;8(1):9-16.
18. Perreault S, Levinton C, Le Lorier J. Efficacy and cost of HMG-CoA reductase inhibitors in the treatment of patients with primary hyperlipidemia. Can J Clin Pharmacol 2000 Autumn;7(3):144-54.
19. Grover SA, C oupal L, Paquet S, Zowall H. Cost- effectiveness of 3-hydroxy-3- methylglutaryl-coenzyme A reductase inhibitors in the secondary prevention of cardiovascular disease:forecasting the incremental benefits of preventing coronary and cerebrovascular events. Arch Intern Med 1999 Mar 22;159(6):593-600.
20. Perreault S, Hamilton VH, Lavoie F, Grover S. Treating hyperlipidemia for the primary prevention of coronary disease. Are higher dosages of lovastatin cost-effective? Arch Intern Med 1998 Feb 23;158(4):375-81.
21. Otten N. A Canadian perspective. Value Health 1998 Nov;1(4):218-23.
22. MacNeil P. Economic aspects of hypercholesterolemia treatment with HMG-CoA reductase inhibitors: a review of recent developments. Can J Cardiol 1998 Apr;14 Suppl A:14A-16A.
23. Riviere M, Wang S, Leclerc C, Fitzsimon C, Tretiak R. Cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease in Canada. CMAJ 1997 Apr 1;156(7):991-7.
24. Perreault S, Hamilton VH, Lavoie F, Grover S. A head- to- head comparison of the cost effectiveness of HMG- CoA reductase inhibitors and fibrates in different types of primary hyperlipidemia. Cardiovasc Drugs Ther 1997 Jan;10(6):787-94 .
25. Hamilton VH, Racicot FE, Zowall H, Coupal L, Grover SA. The cost-effectiveness of HMG- CoA reductase inhibitors to prevent coronary heart disease. Estimating the benefits of increasing HDL-C. JAMA 1995 Apr 5;273(13):1032 -8.
26. Martens LL, Guibert R. Cost-effectiveness analysis of lipid-modifying therapy in Canada: comparison of HMG- CoA reductase inhibitors in the primary prevention of coronary heart disease. Clin Ther 1994 Nov- Dec;16(6):1052-62; discussion 1036.
27. Adis Editors. Generics take off in France, 2006. PharmacoEconomics and Outcomes News;506. p.1.
28. NCEP Expert Panel. Third Report of National Cholesterol Education Program (NCER) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final Report. Circulation 2002;106:3143-3421.
29. Guyton JR. Benefit versus risk in statin treatment. Am J Cardiol 2006 Apr 17;97(8A):95C-97C.
30. Goettsch WG, Heintjes EM, Kastelein JJ, Rabelink TJ, Johansson S, Herings RM. Results from a rosuvastatin historical cohort study in more than 45,000 Dutch statin users, a PHARMO study. Pharmacoepidemiol Drug Saf 2006 Jul;15(7):435-43.
31. McAfee A, Ming E, Seeger J, et al. The comparative safety of rosuvastatin: a retrospective matched cohort study in over 48,000 initiators of statin therapy. Pharmacoepidemiol Drug Saf 2006 Jul;15(7):444-53.
32. Miller PS, Smith DG, Jones P. Cost effectiveness of rosuvastatin in treating patients to low-density lipoprotein cholesterol goals compared with atorvastatin, pravastatin, and simvastatin (a US Analysis of the STELLAR Trial).Am J Cardiol 2005 Jun 1;95(11):1314- 9.
33. Briggs AH, Gray AM. Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess
1999;3(2):1 -134.
34. Brown WV, Bays HE, Hassman DR, et al. Rosuvastatin Study Group. Efficacy and safety of rosuvastatin compared with pravastatin and simvastatin in patients with hypercholesterolemia: a randomized, double-blind, 52-week trial. Am Heart J 2002 Dec;144(6):1036 -43.
35. Olsson AG, Istad H, Luurila O, et al. Rosuvastatin Investigators Group. Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia. Am Heart J 2002 Dec;144(6):1044 -51.
36. Dart A, Jerums G, Nicholson G, et al. A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin
versus simvastatin in patients with hypercholesterolemia. Am J Cardiol 1997 Jul 1;80(1):39-44.
37. Davidson M, Ma P, Stein EA, et al. Comparison of effects on low-density lipoprotein cholesterol and high- density lipoprotein cholesterol with rosuvastatin versus atorvastatin in patients with type IIa or IIb hypercholesterolemia. Am J Cardiol 2002 Feb 1;89(3):268- 75.
38. Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making 1998 Apr-Jun;18(2 Suppl):S68- 80.
39. Weinstein MC. From cost-effectiveness ratios to resource allocation: where to draw the line? In: Sloan FA, ed. Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies. New York: Cambridge University Press, 1995:77-96.
40. PPS Pharma. PPS Pharma Buyers Guide. Moncton: Total Pricing System Inc., January 2006.
41. Brogan. Brogan iMAM. (June 1, 2006) http://www.broganinc.com/ (June 1, 2006).
42. Jones PH, Davidson MH, Stein EA, et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus
atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol 2003 jul 15;92(2):152-60.
43. Anonymous. A switch in time saves more than nine. Two popular statins, Pravachol and Zocor, go generic this summer, paving the way for
significant savings. Harv Heart Lett 2006 May;16(9):1-2.
44. Moon JC, Bogle RG. Switching statins. BMJ 2006 Jun 10;332(7554):1344-5.
45. Canadian Pharmacists Association: Compendium of Pharmaceuticals and Specialties. Ottawa: Canadian Pharmacists Association, 2006.
46. Bullano MF, Wertz DA, Yang GW, et al. Effect of rosuvastatin compared with other statins on lipid levels and national cholesterol education program goal attainment for low- density lipoprotein cholesterol in a usual care setting. Pharmacotherapy 2006 Apr;26(4):469- 78.
47. Nissen SE, Nicholls SJ, Sipahi I, et al. ASTEROID Investigators. Effect of very high- intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006 Apr 5;295(13):1556- 65.
48. Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol 2006 Apr 17;97(8A):27C-31C.
49. Koro CE, Bowlin SJ, Stump TE, Sprecher DL, Tierney WM. The independent correlation between high-density lipoprotein cholesterol and subsequent major adverse coronary events. Am Heart J 2006 Mar;151(3):755.e1-e6.
50. Wei L, Murphy MJ, MacDonald TM. Impact on cardiovascular events of increasing high density lipoprotein cholesterol with and without lipid lowering drugs. Heart 2006 Jun;92(6):746-51.
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BL Tran, Y., Frial, T., & SJ Miller, P. (2018). STATIN’S COST- EFFECTIVENESS: A CANADIAN ANALYSIS OF COMMONLY PRESCRIBED GENERIC AND BRAND NAME STATINS. Journal of Population Therapeutics and Clinical Pharmacology, 14(2). https://mail.jptcp.com/index.php/jptcp/article/view/167
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How to Cite
BL Tran, Y., Frial, T., & SJ Miller, P. (2018). STATIN’S COST- EFFECTIVENESS: A CANADIAN ANALYSIS OF COMMONLY PRESCRIBED GENERIC AND BRAND NAME STATINS. Journal of Population Therapeutics and Clinical Pharmacology, 14(2). https://mail.jptcp.com/index.php/jptcp/article/view/167