Document Detail


Cost-effectiveness analysis of simvastatin and lovastatin/extended- release niacin to achieve LDL and HDL goal using NHANES data.
MedLine Citation:
PMID:  15228376     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (ATP III) encouraged reduced low-density lipoprotein (LDL) cholesterol levels for a greater number of patients and reemphasized the benefits of high-density lipoprotein (HDL) cholesterol. The purpose of this study was to compare 2 regimens achieving simultaneous LDL and HDL goals. METHODS: A decision-analytic model compared the cost-effectiveness of simvastatin and lovastatin/extended-release niacin. The perspective of the analysis was that of a health system. Product labeling was used to determine changes in cholesterol concentrations and frequencies of clinically important adverse events. The Third National Health and Nutrition Examination Survey (NHANES III) adult data were used for baseline cholesterol levels. Each product was titrated to achieve LDL and HDL goals unless an adverse effect occurred. Direct medical costs were determined for each treatment to determine cost-effectiveness. RESULTS: For both the 130 mg/dL and 100 mg/dL LDL goal analyses (and HDL e40 mg/dL), lovastatin/extended-release niacin had higher success rates and lower estimated direct-medical costs than simvastatin. Simvastatin had the highest success rate in achieving LDL level <160 mg/dL and HDL e40 mg/dL; however, its estimated direct-medical cost was approximately twice that of lovastatin/extended-release niacin (665 US dollars versus 333 US dollars). CONCLUSION: For the LDL goals <130 mg/dL and <100 mg/dL (and HDL e40 mg/dL) required of the majority of U.S. residents, lovastatin/extended-release niacin was both more successful and less costly than simvastatin.
Authors:
Edward P Armstrong; Woodie M Zachry; Daniel C Malone
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of managed care pharmacy : JMCP     Volume:  10     ISSN:  1083-4087     ISO Abbreviation:  J Manag Care Pharm     Publication Date:    2004 May-Jun
Date Detail:
Created Date:  2004-07-01     Completed Date:  2004-08-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9605854     Medline TA:  J Manag Care Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  251-8     Citation Subset:  IM    
Affiliation:
Department of Pharmacy Practice, Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA. armstrong@pharmacy.arizona.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cholesterol, HDL / blood*
Cholesterol, LDL / blood*
Cost-Benefit Analysis*
Drug Therapy, Combination
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*,  therapeutic use
Lovastatin / administration & dosage*,  therapeutic use
Male
Middle Aged
Niacin / administration & dosage*
Simvastatin / administration & dosage*,  therapeutic use
Treatment Outcome
United States
Chemical
Reg. No./Substance:
0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 59-67-6/Niacin; 75330-75-5/Lovastatin; 79902-63-9/Simvastatin
Comments/Corrections
Comment In:
J Manag Care Pharm. 2004 May-Jun;10(3):267-70   [PMID:  15228381 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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