OBJECTIVES:

Considering the high prevalence of cardiovascular disease and its risk factors, and that new reference prices have been set for rosuvastatin in Spain, an updated economic assessment is required. We analyzed the cost-effectiveness of rosuvastatin compared to atorvastatin in the treatment of patients at moderate, high and very high cardiovascular risk (≥1% Systematic Coronary Risk Evaluation [SCORE]) from the Spanish National Healthcare System (NHS) perspective.

METHODS:

A Markov model was developed in Microsoft Excel. Four health states were defined: patients without cardiovascular event, cerebrovascular event, coronary event and death. The highest doses of each statin intensity group were compared: rosuvastatin 10mg versus atorvastatin 20mg (moderate-intensity), and rosuvastatin 20mg versus atorvastatin 80mg (high-intensity). A time horizon of 25 years and an annual cycle length were considered. Pharmacological, monitoring, and resource use costs related to cardiovascular events were included in the model. Rosuvastatin and atorvastatin efficacy in terms of c-LDL reduction were taken from the ESC/EAS 2016 European guidelines. Utility values were associated with each health state. A 3% annual discount rate was used for costs and benefits. Incremental cost-effectiveness ratios (ICER) were estimated for each comparison and SCORE risk profile (based on gender, age, total cholesterol, blood pressure and smoking habit). A willingness-to-pay threshold of €30,000/QALY was assumed.

RESULTS:

Overall, 426 SCORE risk profiles were evaluated: 288 moderate, 86 high and 52 very high risk. The ICERs showed that rosuvastatin 10mg was cost-effective versus atorvastatin 20mg in 35% of the moderate profiles, the ICERs remaining were above €30,000/QALY; 98% of the high-risk profiles and 100% of the very high-risk profiles. Atorvastatin 80 mg was dominated by rosuvastatin 20mg, in all of the risk profiles.

CONCLUSIONS:

From the Spanish NHS perspective, Rosuvastatin is a dominant or cost-effective alternative to atorvastatin, in terms of c-LDL reduction, in most SCORE risk profiles.