PHARMACOECONOMIC EVALUATION OF PRAVASTATIN IN THE SECONDARY PREVENTION OF CORONARY HEART-DISEASE IN PATIENTS WITH AVERAGE CHOLESTEROL LEVELS - AN ANALYSIS FOR GERMANY BASED ON THE CARE STUDY

Those people who are to decide about health care systems are increasin gly forced to identify unnecessary costs and achieve savings in health care. Especially for diseases with high prevalence like illnesses of the heart and the circulatory system preventive measures are very impo rtant. This economic analysis tries to clarify whether the secondary-p reventive application of the HMG-CoA reductase-inhibitor pravastatin i s, apart from the clinical benefit, economically justified in patients suffering from coronary heart disease with average cholesterol levels . In the case of this study, the underlying type of economic evaluatio n was an incremental cost-effectiveness analysis. The outcome was defi ned as costs per life-year saved. This retrospective study is based on the results of the CARE (Cholesterol And Recurrent Events) study whic h has been published elsewhere [21]. When calculating costs we took in to account the perspective of 3rd party payers (public health insuranc e) in Germany. The calculation of cost-effectiveness was carried out f or the whole study population in CARE as well as for all patients aged 60 or more years in the CARE study. This was done because the differe nt groups vary by the numbers of avoided myocardial infarctions, strok es and loss of life years. Netcosts for pravastatin therapy, i. e. dru g costs for pravastatin minus costs for avoided events, were about 9.5 4 Mio DM (referring to 1000 patients treated for a period of 5 years). Net-costs for patients aged 60 or more years were 8.18 Mio DM. The ef fectiveness was defined as the number of life years saved and amounted to 216 years of life saved (YOLS) in the overall study group. For pat ients aged 60 or more years we found that 358 years were saved. The co sts per life year saved (i. e. the net-costs of pravastatin therapy di vided through the number of life years saved) turned out to be 44,000 DM per person in the study group. For patients over 60 the costs were 23,000 DM. Lipid-loweringvvith pravastatin in the secondary prevention of coronary heart disease in Germany is cost-effective. In those pati ents aged 60 or more years the use of pravastatin is even more cost-ef fective than in all patients included in the CARE study.