Economic Evaluation of Rosuvastatin and Atorvastatin for the Treatment of Dyslipidemia from a Korean Health System Perspective

Sunghwan Suh; Chang Hee Jung; Soon-Jun Hong; Jung-Sun Kim; Byung Ju Song; Hyun Soon Sohn; Sung Hee Choi

doi:10.12997/jla.2016.5.1.61

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Suh, Jung, Hong, Kim, Song, Sohn, and Choi: Economic Evaluation of Rosuvastatin and Atorvastatin for the Treatment of Dyslipidemia from a Korean Health System Perspective

Original Article

Journal of Lipid and Atherosclerosis 2016; 5(1): 61-77.

Published online: 30 June 2016

DOI: https://doi.org/10.12997/jla.2016.5.1.61

Economic Evaluation of Rosuvastatin and Atorvastatin for the Treatment of Dyslipidemia from a Korean Health System Perspective

Sunghwan Suh¹, Chang Hee Jung², Soon-Jun Hong³, Jung-Sun Kim⁴, Byung Ju Song⁵, Hyun Soon Sohn⁵, Sung Hee Choi⁶

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea.

²Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Division of Cardiology, Korea University College of Medicine, Seoul, Korea.

⁴Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea.

⁵College of Pharmacy, CHA University, Gyeonggi-do, Korea.

⁶Division of Endocrinology and Metabolism, Seoul National University Bundang Hospital, Seongnam, Korea.

Corresponding Author: Sung Hee Choi, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 beon-Gil, Bundang-Gu, Seongnam 13620, Korea. Tel: +82-31-787-7033, Fax: +82-31-787-4052, drshchoi@snu.ac.kr

Received 13 May 2016 Revised 1 June 2016 Accepted 7 June 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study aims to analyze cost-effectiveness of two most-commonly used statins from the perspective of the Korean national health system.

Methods

The scope of the analysis included rosuvastatin (5 mg, 10 mg, and 20 mg) and atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Effectiveness was defined as percentage (%) and absolute (mg/dL) reductions of low-density lipoprotein cholesterol (LDL-C) from the baseline. They were derived from published randomized controlled studies for rosuvastatin and atorvastatin. Effectiveness was defined as reductions in LDL-C levels per mg dose of the drugs. The annual direct medical costs including drug acquisition costs and monitoring costs over the one-year time horizon were calculated for each alternative. The average cost-effectiveness ratios (ACERs) and incremental cost-effectiveness ratios (ICERs) for each statin dose were calculated.

Results

The ACERs for all doses of rosuvastatin (5 mg, 10 mg, and 20 mg) were lower than those for all doses of atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Rosuvastatin 10 mg was the most cost-effective statin for LDL-C reduction. In cost-effectiveness analyses for corresponding doses of rosuvastatin and atorvastatin, rosuvastatin was the superior strategy which suggests both higher effectiveness and lower costs than atorvastatin. However, we have to consider this analysis is highly influenced by current price of statins in each market.

Conclusions

For reduction of LDL-C levels in Korean patients with dyslipidemia, rosuvastatin 10mg is the most cost-effective statin in the current Korean market.

Keywords: Dyslipidemia, Statin, Cost-effectiveness

Figures and Tables

Fig. 1

Average cost-effectiveness ratio by Reduction of LDL-C reduction (mg/dL) from baseline in atorvastatin and rosuvastatin, R; rosuvastatin, A; atorvastatin, LDL-C; low-density lipoprotein cholesterol, ACER; average cost-effectiveness ratio, cost per LDL-C reduction (mg/dL)

Table 1

Effectiveness of each comparator

Dose	Country	Comparators	Reduction of LDL-C from baseline (%)	Reduction of LDC-C from baseline (mg/dL)	Number of Studies
Individual dose	All	R2.5	40.93	65.19	2
		R5	35.97	58.57	7
		R10	45.17	76.58	35
		R20	48.00	78.30	13
		R40	54.77	83.21	11
		R80	53.29	117.84	3
		A5	37.39	43.00	1
		A10	36.50	61.51	27
		A20	43.63	71.63	22
		A40	43.06	77.59	5
		A80	45.57	68.37	16
		R2.5	40.93	65.19	2
		R5	34.05	52.00	4
		R10	47.88	75.35	5
	Asian	R20	49.18	60.00	1
		A5	37.39	43.00	1
		A10	34.02	53.82	9
		A20	49.09	54.00	1
		A40	40.17	47.00	1
Equivalent dose	All	R5 vs. A10	35.97 vs. 32.39	58.57 vs. 52.83	7
		R10 vs. A20	45.42 vs. 45.42	75.48 vs. 71.46	16
		R20 vs. A40	43.93 vs. 43.06	78.28 vs. 77.59	5
		R20 vs. A80	43.93 vs. 45.54	57.55 vs. 59.40	2
	Asian	R5 vs. A10	34.05 vs. 31.04	52.00 vs. 47.67	4
		R10 vs. A20	51.38 vs. 49.09	56.00 vs. 54.00	1^*
		R20 vs. A40	49.18 vs. 40.17	60.00 vs. 47.00	1^*

LDL-C; low-density lipoprotein cholesterol A5, A10, A20, A40, A80 stand for atorvastatin 5 mg, 10 mg, 20 mg, 40 mg, 80 mg, respectively; R2.5, R5, R10, R10, R20, R40 stand for rosuvastatin 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, respectively;

*Study performed in Republic of Korea.

Table 2

Annual cost of monitoring and cost-effectiveness ratio of statin medication

Comparators	Daily cost (won)	Annual cost (won)			Reduction of LDC-C from baseline		ACER
Comparators	Daily cost (won)	Drug	Monitoring	Total	%	mg/dL	Won/%	Won/mg/dL
R 5	346	126,290	206,836	333,126	35.97	58.57	9,261	5,688
R 10	612	223,380	206,836	430,216	45.17	76.58	9,524	5,618
R 20	686	250,390	206,836	457,226	48.00	78.30	9,526	5,839
A 10	663	241,995	206,836	448,831	36.50	61.51	12,297	7,297
A 20	712	259,880	206,836	466,716	43.63	71.63	10,697	6,516
A 40	1,391	507,715	206,836	714,551	43.06	77.59	16,594	9,209
A 80	1,591	580,715	206,836	787,551	45.57	68.37	17,282	11,519

LDL-C; low-density lipoprotein cholesterol, ACER; average cost-effectiveness ratio, cost per LDL-C reduction (mg/dL); A5, A10, A20, A40, A80 stand for Atorvastatin 5 mg, 10 mg, 20 mg, 40 mg, 80 mg, respectively; R2.5, R5, R10, R10, R20, R40 stand for Rosuvastatin 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, respectively.

Table 3

Annual cost of monitoring and cost-effectiveness ratio of statin medication in Asian studies

Comparators	Daily cost (won)	Annual cost (won)			Reduction of LDC-C from baseline		ACER
Comparators	Daily cost (won)	Drug	Monitoring	Total	%	mg/dL	Won/%	Won/mg/dL
R 5	346	126,290	206,836	333,126	34.05	52.00	9,783	6,406
R 10	612	223,380	206,836	430,216	47.88	75.35	8,985	5,710
R 20	686	250,390	206,836	457,226	49.18	60.00	9,297	7,620
A 10	663	241,995	206,836	448,831	34.02	53.82	13,193	8,339
A 20	712	259,880	206,836	466,716	49.09	54.00	9,507	8,643
A 40	1,391	507,715	206,836	714,551	40.17	47.00	17,788	15,203

LDL-C; low-density lipoprotein cholesterol, ACER: average cost-effectiveness ratio, cost per LDL-C reduction (mg/dL); A5, A10, A20, A40, A80 stand for Atorvastatin 5 mg, 10 mg, 20 mg, 40 mg, respectively; R2.5, R5, R10, R10, R20, R40 stand for Rosuvastatin 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, respectively.

Table 4

Incremental cost-effectiveness ratios

Comparators	Annual cost (won)	Difference of Reduction of LDC-C from baseline (R-A)		ICER (%)	ICER (mg/dL)
Comparators	Difference (R-A)	%	md/dL	ICER (%)	ICER (mg/dL)
R 5 vs. A10	-113,347	3.58	5.74	R is dominant	R is dominant
R 10 vs. A20	-37,153	1.97	4.02	R is dominant	R is dominant
R 20 vs. A40	-240,594	0.87	0.69	R is dominant	R is dominant
R20 vs. A80	-324,204	-1.61	-1.85	201,369^*	175,245^*

LDL-C; low-density lipoprotein cholesterol, ICER; incremental cost-effectiveness ratio, additional cost per additional LDL-C reduction; R5, R10, R10, R20 stand for Rosuvastatin 5 mg, 10 mg, 20 mg, respectively; A10, A20, A40, A80 stand for Atorvastatin 10 mg, 20 mg, 40 mg, 80 mg, respectively. *ICER for atorvastatin 80 mg compared to rosuvastatin 20 mg

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Supplementary Material

Supplementary Table 1

Studies included in meta-analysis

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