Aims: To estimate the costs, benefits and cost effectiveness, from the UK NHS perspective, of fluvastatin (relative to no HMG-CoA reductase inhibitor [statin]) for the secondary prevention of major adverse cardiac events following a successful first percutaneous corory intervention (PCI). Methods: A cost-effectiveness alysis was undertaken using efficacy data from the Lescolntervention Prevention Study (LIPS). LIPS was a randomised, double-blind, placebo-controlled trial undertaken in 77 centres (predomintly in Europe). Patients included in the trial had moderate hypercholesterolaemia and had successfully undergone their first PCI. Fluvastatin (Lescol40mg twice daily plus dietary counselling was given to the intervention group for up to 4 years; the control group received dietary counselling only. A Markov model was used to estimate the incremental costs per QALY gained over a 10-year period, with cost data drawn from the UK NHS (2002 values). Monte Carlo simulations and multivariate alysis were used to assess uncertainty. Costs were discounted at 6% per annum, and health outcomes at 1.5% per annum. Results: On average, treatment with fluvastatin cost an additiol 㳰0 (SD 㳰3) [euro423; SD euro428] per patient and resulted in an additiol 0.092 (SD 0.06) QALYs per patient over 10 years compared with controls. The incremental cost per QALY gained with fluvastatin versus the control group was 㳲07 (SD 㵴97) [euro4527; SD euro7759]. Fluvastatin was domint (better outcomes and lower costs) in 15.9% of the simulations and was domited in 2.9%. The key determints of cost effectiveness were: the effectiveness of fluvastatin in reducing acute myocardial infarction, subsequent PCI, corory artery bypass graft and cardiac deaths; the utility weight associated with a subsequent post-PCI state; the cost of fluvastatin; and the time horizon evaluated. Conclusions: Fluvastatin is the only statin which has proven effective in preventing major corory adverse events in new PCI patients; other statins lack this evidence. This Markov model, with its underlying assumptions and data, suggests that fluvastatin is a viable and economically efficient pharmaceutical (relative to no statin) to reduce heart disease in the UK when given routinely to all patients following PCI.
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