Valutazioni economiche di atorvastatina in prevenzione secondaria: un aggiornamento

2011 ◽  
Vol 12 (2S) ◽  
pp. 41-52 ◽  
Author(s):  
Simona De Portu ◽  
Sabato Montella ◽  
Paolo Cortesi ◽  
Enrica Menditto ◽  
Simona Cammarota ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cardiovascular Diseases ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Cost Effective ◽  
Economic Benefits ◽  
Therapeutic Interventions ◽  
Lipid Lowering ◽  
Control Groups ◽  
Mortality And Morbidity

Introduction: cardiovascular diseases are the most common reason of mortality and morbidity in the world, despite therapeutic interventions have improved patients’ prognosis in the last decades. Aggressive lipid lowering treatment with atorvastatin has demonstrated to be effective in preventing the occurrence of new cardiovascular events requiring hospitalizations, in patients previously affected by coronary syndromes. However, the increasing costs of managing cardiovascular diseases impose a careful analysis of the economic benefits of these therapies. Objective: to assess the economic sustainability of using atorvastatin for the secondary prevention of cardiovascular events. Material and Methods: we derived clinical information from five randomized, multicenter trials (AVERT, IDEAL, MIRACL, PROVE-IT, TNT) evaluating efficacy and tolerability of high dosage treatment with atorvastatin over control groups in different patient populations and for different follow up periods. A costeffectiveness analysis in the perspective of the NHS has been performed, under the hypothesis of the imminent price reduction of atorvastatin, due to the loss of exclusivity. Results: in trials AVERT, MIRACL, PROVE IT, the treatment with atorvastatin has demonstrated to reduce both cardiovascular events and overall healthcare direct costs, compared to the respective control groups. In trials IDEAL and TNT, the therapy with atorvastatin has resulted to be cost effective, with incremental cost-effectiveness ratio respectively of € 6,310 for avoided event (vs simvastatin 10 mg) and € 9,058 for CV disease free patient (vs atorvastatin 10 mg). Discussion: the present study represents an update of previous cost-effectiveness analyses, which have previously evaluated the economic consequences of using atorvastatin for the secondary prevention of cardiovascular events. The present analysis has proved the economic benefits deriving from the usage of atorvastatin, which is a dominant alternative in the AVERT, MIRACL and PROVE-IT clinical settings, and a cost effective option in the IDEAL and TNT study populations.

scholarly journals Cost-Effectiveness of Lipid-Lowering Therapies for Cardiovascular Prevention in Germany

2022 ◽  
Author(s):  
Daniel Tobias Michaeli ◽  
Julia Caroline Michaeli ◽  
Tobias Boch ◽  
Thomas Michaeli
Keyword(s):  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Transition Probabilities ◽  
Cardiovascular Prevention ◽  
Lipid Lowering ◽  
Major Adverse Cardiovascular Events ◽  
Icosapent Ethyl ◽  
Use Of Resources ◽  
Statin Monotherapy

Abstract Purpose Novel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. Objective To assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany’s healthcare system. Methods Transition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained. Results For primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € − 10,516 costs (ICER: − 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € − 5,796 (ICER: − 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab. Conclusions For primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.

scholarly journals Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajesh K. Veettil ◽  
Siang Tong Kew ◽  
Kean Ghee Lim ◽  
Pochamana Phisalprapa ◽  
Suresh Kumar ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Low Dose ◽  
Meta Analysis ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Surveillance Colonoscopy ◽  
Combination Strategy ◽  
Effectiveness Analysis

Abstract Background Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC). Methods Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk–benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained. Results According to NMA, the risk–benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective. Conclusion ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.

scholarly journals Cost-Effectiveness Analysis of a Large-Scale Crèche Intervention to Prevent Child Drowning in Rural Bangladesh

2021 ◽  
Author(s):  
Y. Natalia Alfonso ◽  
Adnan A Hyder ◽  
Olakunle Alonge ◽  
Shumona Sharmin Salam ◽  
Kamran Baset ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Societal Perspective ◽  
Large Scale ◽  
Operating Cost ◽  
Cost Effective ◽  
Economic Benefits ◽  
Program Cost ◽  
Rural Bangladesh ◽  
Life Years ◽  
The Cost

Abstract Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche intervention in preventing child drowning. Estimates of the effectiveness of the crèches was based on prior studies and the program cost was assessed using monthly program expenditures captured prospectively throughout the study period from two different implementing agencies. The study evaluated the cost-effectiveness from both a program and societal perspective. Results showed that from the program perspective the annual operating cost of a crèche was $416.35 (95%C.I.: $222 to $576), the annual cost per child was $16 (95%C.I.: $9 to $22) and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,803 (95%C.I.: $9,051 to $27,625). From the societal perspective (including parents time valued) the ICER per life saved was -$176,62 (95%C.I.: -$347,091 to -$67,684)—meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $2,020, the crèche intervention was cost-effective even when the societal economic benefits were ignored. Based on the evidence, the creche intervention has great potential for reducing child drowning at a cost that is reasonable.

scholarly journals PCV84 REHOSPITALIZATION DUE TO SUBSEQUENT CARDIOVASCULAR EVENTS IN SECONDARY PREVENTION PATIENTS TREATED WITH LIPID LOWERING THERAPIES IN ITALY

2019 ◽  
Vol 22 ◽  
pp. S557
Author(s):  
P. Sciattella ◽  
A.P. Maggioni ◽  
M. Belfiore ◽  
F. Sorio Vilela ◽  
D.A. Kahangire ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Lipid Lowering

scholarly journals Ten year cardio-cerebro-vascular mortality and morbidity in a Southern Italy cohort: the VIP Project data

2015 ◽  
Vol 80 (1) ◽  
Author(s):  
Vincenzo Capuano ◽  
Norman Lamaida ◽  
Sergio Torre ◽  
Ernesto Capuano ◽  
Maria Immacolata Borrelli ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Cardiovascular Events ◽  
Southern Italy ◽  
Geographical Area ◽  
Public Health Problem ◽  
Local Analysis ◽  
Mortality Data ◽  
Major Public Health Problem ◽  
Mortality And Morbidity ◽  
European Standard Population

Rationale: In Italy the mortality data were obtained almost exclusively from the data RENCAM (Name Causes of Death Register), while there are few prospective surveys. In order to assess whether there are particular epidemiological conditions in the geographical area of Mercato S. Severino, in Southern Italy, we have studied, and reassessed at ten years (1998/99 - 2008/09), a cohort of adult general population in a project of cardiovascular epidemiology and prevention. Materials and Methods: We calculated the rates of mortality and morbidity from cardiovascular events covering the period 1998/99 - 2008/09, in a cohort of 1200 persons (600 men and 600 women) aged 25 to 74 years. Data were standardized using the European standard population. Results: Mortality from cardiovascular causes was 46,5% in men and 48,7% in women; it was mainly concentrated in the age group 65-74 years where it occurred on 62,9% of deaths in men and 66,7% in women. Regarding morbidity, the incidence of events to ten years of non-fatal myocardial infarction was 2,2% in men and of 1,8% in women. PTCA interventions to ten year have been 3,3% in men and 3,4% in women, the interventions of aorto-coronary bypass have been 2,4% and 0,5% for men and women respectively. While all major cardiovascular events have been more frequent in men, in women there was a higher incidence of stroke (1,6% vs 0,9%). Conclusions: Although by comparison with other European countries Italy is among the countries considered at low-risk of coronary heart disease, in Campania cardiovascular diseases reach higher rates than the rest of the country. Our results are in line with the literature data and confirm that cardiovascular diseases are a major public health problem. Local analysis to propose means to provide useful information for planning prevention interventions targeted to their own territory.

scholarly journals Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017136 ◽  
Author(s):  
Livia Dainelli ◽  
Tingting Xu ◽  
Min Li ◽  
Diane Zimmermann ◽  
Hai Fang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Cardiovascular Events ◽  
Market Price ◽  
Daily Intake ◽  
Milk Powder ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Case Scenario

ObjectiveTo model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events.DesignA best case scenario analysis using a Markov model was conducted.Participants8.67% of 50–79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension.InterventionThe model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results.Main outcome measuresEstimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact.ResultsWith an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results.ConclusionTogether with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50–79 year olds who regularly consume milk in China.

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