Rosuvastatine, atorvastatine en de richtlijn: kosteneffectiviteit in de secundaire preventie

Objective: We assessed the cost-effectiveness of (1) using rosuvastatin compared to generic simvastatin, and (2) using rosuvastatin as the second treatment option after simvastatin compared with atorvastin as the second option. The comparisons are made for patients in secondary prevention with different ages, cholesterol levels and cardiovascular risks. Dutch guidelines favour a generic option as the first choice. Design and methods: The effects on endpoints were modelled using the established link between LDL-cholesterol level and cardiovascular risk. Efficacy and cost data from other studies were used in the Markov model. Results: (1) For 60-year old male patients with LDL-cholesterol levels between 3.5 and 4.5 mmol/l, the incremental cost effectiveness ratio (ICER) is € 30,000 to € 78,000 for 5-year cardiovascular risk levels varying between 15 and 30%. For 50 year old men the ICERs vary between € 19,000 and € 51,000 in the same LDL-cholesterol and risk ranges. (2) For all patient profiles the use of rosuvastatin as the second option leads to lower costs and better effects than the use of atorvastatin. Conclusion: Only for relatively young patients with high LDL-cholesterol levels and very high cardiovascular risks it can be cost-effective to bypass the Dutch guidelines and start treatment with rosuvastatin. Rosuvastatin as the second option is more cost-effective than atorvastin.