Question 9What is the effectiveness of the following adjunctive pharmacotherapy with statins in individuals with FH: statins with any of resins, fibrates, niacin, fish oils, nicotinic acid and ezetimibe (alone or in combination)?

No 257Study Quality:Costs and benefits of Simvastatin 40mg Vs fluvastatin 80 mg in patients with Familial hyperlipidaemia: Technology Assessment Report No 2
Author:Metcalfe S;1997
Relevance Intervention:simvastatin 40mg/day
Comparison:fluvastatin 80mg/day.
Population:This paper examines the incremental benefits and costs of treating patients with FH with simvastatin 40mg/day, over and above the net costs and benefits of treatment with fluvastatin 80mg/day aged between 35–39 years
Perspective:THIRD PAYER
Study type:CUA
Methods:DECISION ANALYSIS using data from 4S, Simon Broome
Health valuations:TTO
Cost components:Direct medical costs
Currency:New Zealand dollar (NZ$)
Cost year:1996
Time horizon:5 years
No discounting was undertaken
Discount rate:7.8%
No discounting was undertaken
Results-cost:Cost difference $771/patient/year
Results-effectiveness:Fluvastatin80mg0.89 QALYS
Simvastatin 40mg1.03 QALYs
Results-ICER:Base case (35–59 years)
$32,947/QALY
55–59 years
$28,112/QALY
Children
$77,000/QALY
Result-Uncertainty:Not done
Source Funding:Public
Comments:The authors did not undertake a sensitivity analysis which weakens their study. In their base case model they assumed fluvastatin will cause a disutility of 0.01 (compared to a disutility of 0.00 for simvastatin), while in their discussion they acknowledge that published studies did not find any difference in utility between the two statins. The implications, which the authors acknowledge, are to exaggerate the QALY gains by simvastatin; hence making the ICERs favourable. It would have been more helpful if they had fully explored this in sensitivity analysis or assumed no difference in the base model.
In conclusion, simvastatin 40mg compared with fluvastatin 80mg used in patients with FH appears to have value for money; this finding is weakened by a lack of sensitivity analysis and, especially, the assumptions about utility loss between the two statins. Their finding seem to contradict our finding that in FH patients, cost effectiveness is favourable for those aged less than 60 years compared to those aged over 60 years.

From: Appendix D, Health economic extractions and excluded studies

Cover of Identification and Management of Familial Hypercholesterolaemia (FH)
Identification and Management of Familial Hypercholesterolaemia (FH) [Internet].
NICE Clinical Guidelines, No. 71.
National Collaborating Centre for Primary Care (UK).
Copyright © 2008, Royal College of General Practitioners.

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