RESUMO
OBJECTIVE: To perform an economics evaluation of lipid-lowering therapy with atorvastatin and simvastatin in patients with hypercholesterolemia in primary care setting. DESIGN: Cost-effectiveness analysis (CEA) has been carried out by means of an open, random, prospective, "real world" study, with hypercholesterolemic patients (total cholesterol [TC] > 240 mg/dl and cLDL > 160 mg/dl). PATIENTS: A total of 92 patients were included (44.8% males), with a mean age of 64.9 +/- 9.4 years old (mean +/- standard deviation). 41.4% were diabetics, 62.1% hypertensives and 16.1% smokers. INTERVENTIONS: Patients were allocated to simvastatin 20 mg/day (44) and atorvastatin. 10 mg/day (48) for 6 months. ASSESSMENT AND MAIN RESULTS: Both therapies reduced significantly cLDL, TC and triglycerides at the end of the study. Atorvastatin reduced lipids faster than simvastatin at 3 months (p < 0.05), but significant differences could not be observed at 6 months. Atorvastatin reduced cLDL levels by 21.5 +/- 13.2% and 23.8 +/- 13.9% at 3 and 6 months, respectively, versus 16.4 +/- 14.2% and 22.8 +/- 10.8% with simvastatin. By these reductions, 54.2% of patients treated with atorvastatin and 50.0% of those allocated to simvastatin reached therapeutic goals of cLDL control. Atorvastatin 10 mg was more cost-effective than simvastatin 20 mg; 95,406 versus 101,335 pts per patient reaching therapeutic goals, respectively, which means that simvastatin need an extra cost of 24,833 pts per patient reaching therapeutic goals to be as efficient as atorvastatin. Sensitivity analysis to control for uncertainty confirmed the results of cost-effectiveness analysis. CONCLUSIONS: Both statins were effective as lipid-lowering agents. However, atorvastatin 10 mg was more efficient than simvastatin 20 mg due to a better cost-effectiveness ratio.
