• 26
  • Atorvastatin calcium: PLACE IN THERAPY(8)

Comparison of price on the basis of a cost per percentage of cholesterol (specifically LDL-C) reduction has also been evaluated in the literature as an appropriate measure for evaluating treatment for similar degrees of cholesterol (LDL-C) reduction . This measure essentially equalizes the differences in efficacy and cost, comparing direct drug costs only. Application of this procedure to efficacy data obtained from the only prospective, randomized, clinical trial comparing available HMG-CoA reductase inhibitors resulted in atorvastatin (10 mg/day) providing the lowest cost (in American dollars) per percentage of LDL-C reduction . Applying Canadian drug costs to such an analysis also shows that atorvastatin has the lowest cost per percentage of LDL-C lowering compared with available HMG-CoA reductase inhibitors (Table 9).

TABLE 9 Cost per percentage of low density lipoprotein cholesterol (LDL-C) reduction: Analysis of hydroxy-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors

Drug Dose Cost/day % LDL-C reduction Cost/day/% LDL-C reduction
Atorvastatin 10 mg $1.60 -38.2 $0.042
Brand 20 mg $1.73 -28.6 $0.061
Generic 20 mg $1.30 -28.6 $0.045
Simvastatin 10 mg $1.78 -28.4 $0.063
Pravastatin 20 mg $1.78 -23.5 $0.076
Fluvastatin 20 mg $0.75 -16.4 $0.046

Cost/day was determined by using the unit price from the Ontario Drug Benefit Formulary (reference 138). Percentage LDL-C reduction was determined from a single randomized, comparative study of all available HMG-CoA reductase inhibitors (reference 53)

Other long term studies (one year) have compared the direct costs of treating patients with risk factors for CAD or patients with documented CAD and/or peripheral vascular disease to target LDL-C levels . Patients were treated with atorvastatin, simvastatin, lovastatin or fluvastatin, and were allowed combination therapy with colestipol if they did not reach target LDL-C levels following dose titration up to the maximum allowed dose of the HMG-CoA reductase inhibitors. Treatment goals were as follows: 3.4 mmol/L for patients with two or more risk factors, 4.1 mmol/L for patients with fewer than two risk factors and 2.6 mmol/L or less for patients with documented CAD and/or peripheral vascular disease. Evaluations included costs related to physician visits, lipid measurements, cheap medications dispensed and physician services related to adverse events. The data showed that patients treated with atorvastatin reached LDL-C treatment goals (according to NCEP guidelines) more often and more quickly than patients treated with simvastatin, lovastatin or fluvastatin. Patients receiving atorvastatin also required fewer dose titrations, fewer patient visits and less combination therapy (with colestipol) than those treated with the other HMG-CoA reductase inhibitors. Overall, the data from these studies demonstrate that the direct cost of treating patients until LDL-C goals were reached was significantly lower with atorvastatin than with the other HMG-CoA reductase inhibitors tested (Table 10).

TABLE 10 Mean resource utilization and costs (for patients attaining treatment low density lipoprotein cholesterol goals)

Atorvastatin Simvastatin Lovastatin Fluvastatin
Coronary artery disease patients n=80 n=77 n=81 n=80
Costs associated with physician visits (US$) $548 $622 $636 $710
Cost of drugs (US$) $760 $984 $1597 $947
Total cost* (US$) $1313 $1614 $2235 $1670
Difference versus atorvastatin (US$) $301 $922 $357
Patients with risk factors n=86 n=87 n=86 n=85
Cost associated with physician visits (US$) $385 $541 $526 $656
Cost of drugs (US$) $446 $797 $1188 $752
Total cost* (US$) $833 $1345 $1724 $1422
Difference versus atorvastatin (US$) $512 $891 $589

Total costs include costs associated with adverse events. Adapted with permission from reference 152


Online Pharmacy