Using lower cost statins improves outcomes for normal cholesterol non-diabetic patients

<p><b>Background</b>: The American College of Cardiology recommends considering initiation of cholesterol-lowering therapy in normal cholesterol adults aged 45–70, who are either diabetic or have a 10 year atherosclerotic cardiovascular disease risk higher than 7.5%. Although this policy was shown to be cost-effective, the multi-billion dollar budget impact may limit the adoption, diffusion and overall clinical impact of this therapy.</p> <p><b>Objectives</b>: We examined whether using a substantially lower cost statin (Simvastatin) in a much wider population, while accepting almost-as-good per-patient outcomes can provide better outcomes for the entire intended use population (IUP) under a pre-specified budget constraint.</p> <p><b>Methods</b>: We built a model to compare the outcomes on the entire IUP, and compared branded Rosuvastatin to Simvastatin. Outcomes measured were major adverse cardiovascular events (MACE): cardiovascular death, stroke, myocardial infarction, and hospitalization for revascularization or unstable angina.</p> <p><b>Results</b>: The branded Rosuvastatin alternative resulted in the prevention of 6,571 MACE compared to 311,698 MACE with Simvastatin, and 83,120 MACE with generic Rosuvastatin.</p> <p><b>Conclusions</b>: Under budget constraints, using Simvastatin instead of branded Rosuvastatin resulted in a 47 fold increase of prevention of MACE for the entire IUP. These results should be considered while initiating statin therapy in this target population.</p

Phylogeny

Phylogeny used for testing patterns of phylogenetic signal. Modified from Pyron & Wiens 2013. See Appendix for details on how species were added to the tree

Full dataset on disease patterns and traits

Data on species' infection patterns (prevalence and intensity) and survival during epizootic events (testing dataset) with full suite of traits. Raw trait data (unimputed) is also included. See the Appendix for full details of trait data collection and explanation

Additional file 1: of Lessons learned from the 2009–2010 H1N1 outbreak for the management of the 2013 silent polio outbreak

Table S1. Study protocols. Questionnaire that was used during interviews. (DOCX 13 kb