Cost-effectiveness of managing familial hypercholesterolemia using atorvastatin-based preventive therapy

Introduction and objectives. A cost-effectiveness model was developed to evaluate the efficiency of different preventive strategies in familial hypercholesterolemia. (FH) in comparison with routine clinical practice (CP): atorvastatin monotherapy, 40 mg (A40) or 80 mg (A80), and atorvastatin combined with ezetimibe, 10 mg (A40+E10 0 or A80+E1 0). Methods. A longitudinal population model with a time horizon for life-expectancy was developed within the context of the Spanish public healthcare system. Life tables for the Spanish population (2002) were modified using the standardized mortality rate for individuals with FH. Effectiveness was expressed in life-years gained (LYG), after taking into account reductions for risk (ie, Framingham risk score) and cardiovascular mortality. The costs (in 2005 terms) of the intervention (Cl) and care (CC) were discounted at 6%, while effects were discounted at 3%. Results. Routine CP, based on the Spanish FH registry: 1.97 LYG per patient vs. no treatment; Cl is an element of 5321, CC is an element of 23,389. A40: 2.59 LYG; reduction in CC compared with CP 4.5%; total costs (TC) is an element of 30 569. A80: 2.75 LYG; reduction in CC 6.4%; TC is an element of 30 133. A40+E10: 3.38 LYG; reduction in CC 14.3%; TC is an element of 36 104. A80+E10: 3.62 LYG; reduction in CC 17.6%; TC is an element of 35 317. From most to least efficient strategy, the incremental cost-effectiveness per LYG compared with CP was: a) A80: is an element of 1821; b) A40: is an element of 3012; c) A80+E10: is an element of 4021, and d) A40+E10: is an element of 5250. Conclusions. Preventive treatment of FH with atorvastatin was cost-effective. The greatest cost-eff ectiveness was obtained with atorvastatin monotherapy, 80 mg. The addition of ezetimibe could produce further benefits at an acceptable incremental cost.