802-6 The Cost-Effectiveness of Pravastatin in Secondary Prevention of Coronary Heart Disease

To determine the cost-effectiveness of pravastatin therapy in patients with coronary heart disease, a projected risk model was developed that used the results of the three-year, double blind, placebo controlled clinical trials: Pravastatin Limitation ofAtherosclerosis in the Coronary Arteries (PLAC I) and Pravastatin, Upids and Atherosclerosis in the Carotid Arteries (PLAC II). In addition to measuring atherosclerotic progression, the PLAC studies evaluated four outcome variables: coronary heart disease death, non-coronary heart disease death, fatal myocardial infarction, and non-fatal myocardial infarction in a patient population (mean age 60 years) with established coronary heart disease and moderate low-density-lipoprotein cholesterol levels, Pooled PLAC data analysis (n=559) revealed a statistically significant (p<0.05) difference in male non-fatal myocardial infarctions between the pravastatin and placebo groups. The projected risk model utilized Framingham data to project the risk of mortality 10 years post myocardial infarction. Markov Process was used to estimate the life-years saved and cost. All costs and benefits were discounted by 5%, Results are presented in the table below:Patient Risk ProfileCost per Life-Year SavedMale with CHD + 1Additional Risk Factor$19,082Male with CHD + 2 Additional Risk Factors$14,022Male with CHD + 3 Additional Risk Factors$10,630Based on this model, pravastatin monotherapy in secondary prevention of coronary heart disease has a cost-effectiveness ratio comparable to some of the widely accepted medical interventions such as breast cancer screening,$21,700, hydrochlorothiazide in the treatment of hypertension, $16,400, and pneumococcal vaccine,$12,000