J Lipid Atheroscler.  2012 Dec;1(2):87-94. 10.12997/jla.2012.1.2.87.

Cost-effectiveness of the Use of Statins in the Korean Population

• Han KH
• Kim HJ
• Kim JJ

• KMID: 2198366
• DOI: http://doi.org/10.12997/jla.2012.1.2.87

Abstract

OBJECTIVE
Statins reduce risk of cardiovascular disease through lowering of LDL-C (Low Density Lipoprotein cholesterol). We analyzed cost-effectiveness of statins in the reduction of serum LDL-C level among Korean population at high cardiovascular risk.
METHODS
Rosuvastatin (5, 10, and 20 mg), atorvastatin (10, 20, 40, and 80 mg) and simvastatin (20, 40, and 80 mg) were included for the analysis, because those statins and doses were mostly prescribed in Korea. We determined effectiveness as % reduction of LDL cholesterol (LDL-C) levels per mg dose and % population reached to the ideal LDL-C level (<100 mg/dL), which is the target goal of LDL-C level for the high cardiovascular risk group as recommended by NCEP-ATP III guideline. The annual cost, which included overall cost for the drug price and management during follow up, was calculated. Average cost-effectiveness ratio (ACER) was calculated and used as the parameter representing cost-effectiveness of each statins.
RESULTS
The lowest dose of each statins showed that achieving LDL-C target level was not high even in subjects showing relatively low basal LDL-C levels (<160 mg/dL). Also in case basal LDL-C level was over 160 mg/dL, the majority of statins were not sufficient to control LDL-C levels except atorvastatin 80 mg. In case of basal LDL-C level was lower than 160 mg/dl, atorvastatin 20 mg was the most cost-effective statin for LDL-C reduction regardless of considering basal LDL-C level. Simvastatin 40 mg was also cost-effective if basal LDL-C levels were between 100-129 mg/dL.
CONCLUSIONS
For the reduction of LDL-C level in high risk subjects showing moderately elevated basal LDL-C level, atorvastatin 20 mg is the most cost-effective statin treatment strategy and then simvastatin 40 mg or rosuvastatin 10 mg was the second best option.

Keyword

Statins; LDL cholesterol; Cost-effectiveness; Average cost-effectiveness ratio (ACER); Korea

MeSH Terms

Cardiovascular Diseases
Cholesterol, LDL
Fluorobenzenes
Follow-Up Studies
Heptanoic Acids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Korea
Lipoproteins
Pyrimidines
Pyrroles
Simvastatin
Sulfonamides
Atorvastatin Calcium
Rosuvastatin Calcium
Cholesterol, LDL
Fluorobenzenes
Heptanoic Acids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lipoproteins
Pyrimidines
Pyrroles
Simvastatin
Sulfonamides

Figure

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  Fig. 1 Model of analyzing cost-effectiveness of statin medication.

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  Fig. 2 (A-C) ACER by LDL-C goal achievement percent according to basal LDL-C level. (D-F). LDL-C goal achievement percent (effectiveness on X-axis) and annual cost (cost on Y-axis) of statins according to LDL-C level. A: Atorvastatin, R: Rosuvastatin, S: Simvastatin, LDL-C: low density lipoprotein-cholesterol, ACER: average cost-effectiveness ratio

• 

  Fig. 3 Statins' ACER by LDL-C reduction percent. LDL-C; low density lipoprotein-cholesterol, ACER; average cost-effectiveness ratio

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