Project example 14: High dose statins

Project type	Cost-effectiveness analysis
Indication	Acute Coronary Syndrome (ACS)
Intervention	High dose statin therapy
Methods	Bayesian analysis Markov modeling
Countries	UK Spain Sweden Netherlands
Deliverables	Cost-effectiveness model for statin therapy in ACS patients Technical report Pharmacoeconomic dossier for reimbursement application
Presentations	International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference. Athens 2008. Poster presentation. International Health Economics Association (iHEA) conference. Beijing 2009. Podium presentation.

This project aimed to assess the cost-effectiveness of high dose branded statin therapy in comparison to a generic statin in lower doses for the secondary prevention of cardiovascular events in patients with Acute Coronary Syndrom (ACS). As no direct comparisons for the treatments of interest were available for the ACS population, paparameter values had to be estimated based on available data of other statin therapies in non-ACS patients. A Bayesian framework was designed such that it allowed us to estimate the parameters of interest based on various indirect comparisons. Information was sourced from trial data and from available meta-analyses. The Bayesian analysis took event rate data from three clinical trials of statin therapy in ACS patients and priors from two published meta-analyses to estimate short-term event-specific risk reduction values. These values were subsequently used as inputes for the cost-effectiveness model. A number of health states, and their associated costs and effects were considered in a Markov model. The short-term probability estimates were extrapolated to a lifetime horizon, taking into consideration the effect of age and prior events on patient risk. The analyses have been performed from the societal perspective of four European countries and reported in pharmacoeconomic dossiers. The results have also been presented at two international scientific meetings.