Cost-minimization analysis of simvastatin versus atorvastatin for maintenance therapy in patients with coronary or peripheral vascular disease

Background: Previous health economic studies have demonstrated the cost-eff ectiveness of simvastatin in the treatment of coronary heart disease (CHD) based on clinical results of the Scandinavian Simvastatin Survival Study. A prior analysis evaluated the "cost of getting to goal," but ignored all co sts after titration. However, when evaluating the cost-effectiveness of lon g-term therapies, it is important to consider the maintenance costs as well . Objective: The purpose of this study was to evaluate the maintenance costs of treatment with simvastatin versus that of treatment with another more re cently available statin, atorvastatin, in a European context. Methods: We assessed the long-term maintenance cost of simvastatin versus a torvastatin in terms of the cost of reducing low-density lipoprotein choles terol (LDL-C) levels to the recommended goals based on a previously publish ed clinical trial in patients with CHD. The analysis focused on the patient s in the original clinical trial who were randomized to treatment with simv astatin or atorvastatin. Patients began therapy with 10 mg of simvastatin o r atorvastatin: the dose of study drug was titrated every 12 weeks up to 30 mg simvastatin or 80 mg atorvastatin. with the addition of up to 8 g/d of cholestyramine until a modified European Atherosclerosis Society LDL-C goal (less than or equal to2.84 mmol/L) was reached. As there was no significan t difference between the 2 groups in resource utilization for adverse event s, only drug costs were included. The calculated average annual maintenance cost was based on the distribution of the final daily dosing regimens and the public drug prices fur each regimen. individual country analyses were c onducted using each local currency. Results: There was no significant difference between groups in the percenta ge of patients reaching their LDL-C goal over the study period (80% for sim vastatin-treated pa-tients vs 89% for atorvastatin-treated patients, P = 0. 135). However, the cost of maintaining a similar percentage of patients at their appropriate LDL-C levels was significantly lower in the simvastatin g roup compared with the atorvastatin group in 13 of the 17 countries assesse d. In the remaining 4 countries, there was a cost advantage for simvastatin , but it did not reach statistical significance. Conclusions: Across Europe there was a significant reduction in the cost of maintaining patients at their appropriate LDL-C levels with simvastatin ve rsus atorvastatin. The results of this analysis, along with the proven clin ical benefits of simvastatin, support the use of this drug as the treatment of choice in the secondary prevention of CHD.