A comparative economic analysis of simvastatin versus atorvastatin: Results of the Surrogate Marker Cost-Efficacy (SMaC) study

Health care payers have become increasingly interested in economic analyses to guide the allocation of limited health care resources. The Surrogate Ma rker Cost Efficacy (SMaC) study was undertaken to assess the economics of t reatment with simvastatin versus treatment with atorvastatin in reducing lo w-density lipoprotein cholesterol (LDL-C) in patients in 10 European countr ies, based on the results of a 1-year, double-blind, parallel-group clinica l trial. Participants were between 18 and 80 years of age (n = 177; median age, 57; 94 men and 83 women). Entry criteria were a baseline LDL-C value b etween 4.2 and 7.8 mmol/L (160 to 300 mg/dL) and a triglyceride value less than or equal to 14.5 mmol/L (400 mg/dL). Patients were randomly assigned t o receive simvastatin 10 mg or atorvastatin 10 mg. At 16 weeks, any patient s not reaching their appropriate LDL-C level received simvastatin 20 mg/d o r atorvastatin 20 mg/d. Patients were then followed up for a total of 52 we eks. The overall euro cost analysis was based on the weighted average price of each product across all the independent pharmaceutical markets based on official euro conversion rates. Individual country analyses also were cond ucted in each local currency. Over the 52-week study, there were no signifi cant differences in the percentage of patients achieving an appropriate LDL -C level (simvastatin 48%, atorvastatin 50%). In the overall euro cost anal ysis, the cumulative cost of atorvastatin (134 euros) was 33% more than for simvastatin (101 euros) during the first 16 weeks. After titration to 20 m g, the total cost of treatment during the 52-week study remained significan tly lower in the simvastatin group than in the atorvastatin group (429 vs 5 38 euros; P < 0.0001). In individual country analyses, therapy with simvast atin was significantly less expensive than therapy with atorvastatin in 8 o f 10 countries (P = 0.001 to 0.003). In the remaining 2 countries, there wa s no significant difference in cost. Across the countries included in the e valuation, there was a significant reduction in the cost of getting patient s to appropriate LDL-C levels with simvastatin compared with atorvastatin. These results should provide useful information for physicians and payers; however, additional long-term clinical trials are required to assess fully how treatment with atorvastatin affects patient outcomes, safety, and costs .