Efficacia clinica e costo-efficacia di atorvastatina a elevati dosaggi nella prevenzione degli eventi cardiocerebrovascolari

Berto, P.
Lopatriello, S.

¹ Professore a contratto, Università di Padova
² PBE Consulting, Verona

Indirizzo per la corrispondenza: Dott.ssa Patrizia Berto, pbe consulting, Vicolo Stella 6, 37121 Verona. E-mail [email protected]

Giornale Italiano di Health Technology Assessment 4(1):p 17-31, August 1, 2011. | DOI: 10.2165/11590810-000000000-00000

Clinical efficacy and cost-effectiveness of high-dose atorvastatin for the secondary prevention of cardiocerebrovascular events

In the European Union cardiovascular diseases account for more than 2 million deaths per year, of which almost half are due to coronary artery disease, which has a significant impact on costs for health services. Nowdays one of the main cardiovascular risk factors is high cholesterol. Several randomized controlled trials have shown a beneficial role of statins in reducing cholesterol levels. The aim of this work is to summarize the efficacy data, the safety of use and cost-effectiveness of atorvastatin at high doses (80 mg/die) compared to the main treatment options available today.

The efficacy and safety of atorvastatin were evaluated through a review of the scientific literature and clinical trials as well as post marketing and real world studies. Results of all available cost-effectiveness analysis are reported adopting a National Health Service (NHS) perspective. That is why only direct medical costs were identified and valued.

The efficacy and safety of atorvastatin is high. Atorvastatin is effective in both primary and secondary prevention of coronary heart disease, and also in the secondary prevention in patients with acute coronary syndrome as well as patients undergoing coronary revascularization. Furthermore, atorvastatin is effective in preventing cardiovascular events in patients affected by diabetes or metabolic syndrome. Atorvastatin, at all prescribed doses, shows an excellent safety profile (the incidence of adverse events is not dose-dependent). With reference to the economic evaluation, atorvastatin (80 mg/die) has shown to be cost-effective or dominant versus placebo, simvastatin 20 mg, pravastatin 40 mg, PTCA, and versus lower doses of atorvastatin (10 mg/day and 20 mg/day).

The effects of atorvastatin are beneficial both in the societal (improved patients' quality of life) and in the NHS' perspectives (monetary savings).