THE COST OF REACHING NATIONAL-CHOLESTEROL-EDUCATION-PROGRAM (NCEP) GOALS IN HYPERCHOLESTEROLEMIC PATIENTS - A COMPARISON OF ATORVASTATIN, SIMVASTATIN, LOVASTATIN AND FLUVASTATIN

Objective: Recognising the importance of treating hyperlipidaemia, the National Cholesterol Education Program (NCEP) has established widely accepted treatment goals for low density lipoprotein cholesterol (LDL- C). Medications used most commonly to achieve these LDL-C goals are HM G-CoA reductase inhibitors. The relative resource utilisation and cost associated with the use of reductase inhibitors of different LDL-C lo wering efficacy are unknown, but are major health and economic concern s. The objective of this study was to determine the mean total cost of care to reach NCEP goals with various reductase inhibitors. Design: I n a randomised, 54-week, 30-centre controlled trial we compared resour ces used and costs associated with treating patients to achieve NCEP g oals using 4 reductase inhibitors: atorvastatin, simvastatin, lovastat in and fluvastatin. Patients and participants: The trial studied 662 p atients; 318 had known atherosclerotic disease. Interventions: Reducta se inhibitor therapy was initiated at recommended starting doses and i ncreased according to NCEP guidelines and package insert information. For patients who did not reach the goal at the highest recommended dos e of each reductase inhibitor, the resin colestipol was added. Main ou tcome measures and results: Patients treated with atorvastatin, compar ed with other reductase inhibitors, were more likely to reach NCEP goa ls during treatment (p < 0.05). required fewer office visits (p < 0.00 1) and less adjuvant colestipol therapy (p = 0.001). Consequently, the mean total cost of care (1996 values) to reach NCEP goals was lower w ith atorvastatin [$US 1064; 95% confidence interval (CI): $US953 to $U S1176] compared with simvastatin ($US1471; 95% CI: $US1304 to $US1648) , lovastatin ($US1972; 95% CI: $US1758 to $US2186) and fluvastatin ($U S1542: 95% CI: $US1384 to $US1710). Results were similar for patients with or without known atherosclerotic disease. Conclusions: In patient s requiring drug therapy for hypercholesterolaemia, NCEP LDL-C goals a re achieved significantly more often using fewer resources with atorva statin compared with simvastatin, lovastntin or fluvastatin.