Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population.
Annemans, L.; Marbaix, S.; Webb, K.et al.
2010 • In Clinical Drug Investigation, 30 (2), p. 133-42
[en] BACKGROUND AND OBJECTIVE: Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has been demonstrated in several randomized, controlled trials, including the CARDS clinical trial. Based on the clinical CARDS data, the favourable cost effectiveness of atorvastatin 10 mg in patients with type 2 diabetes has been demonstrated in countries such as the UK and France. This study aimed to estimate the cost effectiveness in the Belgian setting of atorvastatin 10 mg compared with no treatment for the primary prevention of CV events in type 2 diabetes patients without a history of CV disease. METHODS: A Markov model with 1-year cycles was developed to simulate the CV event and death risk according to the therapeutic approach initiated. The transition probabilities for CV events in the 'no statin treatment' group were derived from the risk equations reported from the large UKPDS. Risk reductions from the CARDS clinical trial were used to adjust these CV event probabilities in the atorvastatin 10 mg treatment group. The characteristics of type 2 diabetes patients without a CV history were derived from the Belgian OCAPI survey. The public healthcare payers' perspective was taken into account for costing. The direct medical costs of CV events were based on the Public Health Authorities' hospital database for acute care costs and on the literature for the follow-up costs. The impact on the reimbursement system of generic entry to the market was considered in the drug cost. Costs were valued as at year 2009; costs and outcomes were discounted at 3% and 1.5%, respectively. RESULTS: Based on a 5-year time horizon, atorvastatin was demonstrated to be cost effective with an incremental cost/quality-adjusted life-year (QALY) of euro 16,681. Over a lifetime horizon (25 years), atorvastatin was demonstrated to be a cost-saving therapeutic intervention. At a threshold of euro 30,000/QALY, atorvastatin had a 98.8% probability of being cost effective. CONCLUSION: Compared with 'no treatment', use of atorvastatin 10 mg as a primary prevention intervention in Belgian type 2 diabetes patients not only improves CV outcomes, but also appears to be cost saving over a lifetime horizon.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Language :
English
Title :
Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population.
Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical trial practice: executive summary. The Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2007 Oct; 28 (19): 2375-2414
Jönsson B. Revealing the cost of type II diabetes in Europe. Diabetologia 2002; 45: S5-12
Wallemacq C, Van Gaal LF, Scheen AJ. Le coût du diabète de type 2: résumé de l'enquête européenne CODE-2 et analyse de la situation en Belgique. Rev Med Liège 2005; 60 (5-6): 278-284
Ryden L, Standl E, Bartnik M, et al., Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC); European Association for the Study of diabetes (EASD). Guidelines on diabetes, pre-diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28: 88-136
Paquot N, Vandenberghe H, Scheen AJ, et al. Glycaemic and blood pressure control seems harder to improve than lipid control in type 2 diabetic patients: comparison of two surveys over 5 years in Belgium [abstract A-08-953-EASD]. Presented at the European Association for the Study of Diabetes (EASD); 2008 Sep 7-11; Rome
Colhoun HM, Betteridge DJ, Durrington PN, et al., on behalf of the CARDS Investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): a multi-centre randomized placebo-controlled trial. Lancet 2004; 364: 685-696
Raikou M, McGuire A, Colhoun HM, et al. Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS). Diabetologia 2007; 50: 733-740
Lafuma A, Colin X, Solesse A. Cost-effectiveness of atorvastatin in the prevention of cardiovascular events in diabetic patients: a French adaptation of CARDS. Arch CVD Dis 2008; 101: 327-332
Ramsey SD, Clarke LD, Roberts CS, et al. An economic evaluation of atorvastatin for primary prevention of cardiovascular events in type 2 diabetes. Pharmacoeconomics 2008; 26 (4): 329-339
Stevens RJ, Kothari V, Adler AI, et al. The UKPDS risk engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci 2001; 101: 671-679
Kothari V, Stevens RJ, Adler AI, et al. UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine. Stroke 2002 Jul; 33 (7): 1776-1781
Haffner SM, Letho S, Ronnemma R, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New Engl J Med 1998; 339: 229-234
National Institute for Statistics [online]. Available from URL: http://www.statbel.fgov.be [Accessed 2009 Aug 1]
Debacker N, Mathieu C, Nobels F, et al. Initiative pour la promotion de la qualité et épidémiologie du diabète sucré IPQED, rapport résultats 2005-2006 [report no. 2007-010]. Institut Scientifique de Santé Publique, Section Epidémiologie [online]. Available from URL: http: //www.iph.fgov. be/epidemio [Accessed 2009 Aug 1]
TCT database [online]. Available from URL: http://www. tct.fgov.be [Accessed 2009 Aug 1]
Annemans L, Lamotte M, Levy E, et al. Cost-effectiveness analysis of clopidogrel versus aspirin in patients with atherothrombosis based on the CAPRIE trial. J Drug Assessment 2003; 6: 107-120
Annemans L, De Backer W, Van Rompay W, et al. Evaluation of the costs of coronary heart disease in Belgium. Podium presentation at ISPOR Third Annual Congress; 1998 May 27-30; Philadelphia (PA)
Muls E, Van Ganse E, Closon MC. Cost-effectiveness of pravastatin in secondary prevention of coronary heart disease: comparison between Belgium and the United States of a project risk model. Atherosclerosis 1998; 137 (Suppl.): 111-116
Briggs A, Sculpher M, Claxton K. Decision modelling for health economic evaluation. Oxford: Oxford University Press, 2006: 86-92
INAMI [online]. Available from URL: http://www.inami. be [Accessed 2009 Aug 1]
Huang ES, Morgan S, Jin L, et al. The impact of patient p on the cost-effectiveness of intensive glucose control in older patients with new-onset diabetes. Diabetes Care 2006 Feb; 29 (2): 259-264
Maddigan SL, Feendy DH, Majumdar SR, et al. Understanding the determinants of health for people with type 2 diabetes. Am J Public Health 2006 Sep; 96 (9): 1649-1655
Cleemput I, Van Wilder Ph, Vrijens F, et al. Recommandations pour les évaluations pharmacoéconomiques en Belgique. KCE report 78B, 2008 [online]. Available from URL: http://www.kce.be [Accessed 2009 Aug 1]
Beck JR, Pauker SG, Gottlieb JE, et al. A convenient approximation of the life expectancy (the DEALE): II. Use in medical decision-making. Am J Med 1982 Dec; 73 (6): 889-897