Are Intensive Lipid-lowering Regimens an Optimal Economic Strategy in Patients with ACS? An Acute and Chronic Perspective

Roberta Ara; Rachid Rafia; Sue E Ward; Anthony S Wierzbicki; Tim M Reynolds; Angie Rees; Abdullah Pandor


Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):423-433. 

In This Article

Five-year View

While the economic evaluations suggest that an intensive-dose, lipid-lowering strategy is a cost-effective alternative to standard-dose treatments in patients with ACS, there are currently no economic studies that compare intensive dose combination strategies with generic standard-dose treatments prescribed in clinical practice. These should incorporate treatment-specific adherence and adverse event rates as observed in long-term use in general clinical practice. Data on adverse event rates in clinical practice for the more potent dose statins are required to ensure any future modeling exercises accurately reflect what is observed in general practice. Economic evaluations comparing the cost–effectiveness of all the different alternatives available are required to inform policy decision-makers of the potential optimal strategy when the patent for atorvastatin expires in 2011. Data on adverse event rates in clinical practice should be collected and made available to analysts to inform future evaluations. Assumptions for future health policy will depend on the rate of reduction in the price of atorvastatin compared with price changes in other potent statins. In 2010–2012, clinical event data will begin to become available for other methods of reducing LDL-C with the conclusion of the ezetimibe–simvastatin trial in acute coronary syndromes. Additional complexity will be added to the analyses as trial data becomes available for the combination of fibrates with statins in patients with diabetes (ACCORD),[107] and later niacin with statins in secondary prevention with allied dyslipidemia (Niacin Plus Statin to Prevent Vascular Events [AIM-HIGH])[108] or without (HPS2-THRIVE)[109] which will necessitate adding effects on high-density lipoprotein-cholesterol and possibly triglycerides to models currently focusing on LDL-C. Clinical data on the benefits of combination treatment strategies including treatment for hypertension and lipids would be useful to inform future economic modeling, as the cost–effectiveness of treatments are generally considered in isolation.


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