Carrageta, M

Gouveia-Pinto, C

Silva-Miguel, L

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A102 Abstracts
increased over the years; in 1996 13.7% of the patients started
with at least an equipotent dose of four (simvastatin 20mg or
equipotent) while in 2004 88.4% of all patients started on at
least an equipotent dose of four. Goal attainment increased from
42% in years prior to 2001 to 59% in 2002–2004 and was high
in patients with cardiovascular disease and diabetes (43% versus
69%). CONCLUSIONS: Although in recent years aggressive
statin treatment and lower baseline TC levels led to higher goal
attainment 41% of the patients still did not reach goal. There-
fore even more effective and well tolerated lipid lowering thera-
pies seem to be required.
PCV44
COST-EFFECTIVENESS OF ROSUVASTATIN IN THE
PREVENTION OF ISCHEMIC HEART DISEASE IN PORTUGAL
Gouveia-Pinto C1, Carrageta M2, Silva-Miguel L3
1Instituto Superior de Economia e Gestão,Technical University of
Lisbon, Lisbon, Portugal; 2Garcia de Orta Hospital, Almada, Portugal;
3Research Centre on the Portuguese Economy—CISEP, Lisbon,
Portugal
OBJECTIVES: To analyse the cost-effectiveness of Rosuvastatin
compared to Atorvastatin in the treatment of hypercholes-
terolemia and prevention of ischemic heart disease (IHD) in 
Portugal. METHODS: A probabilistic Markov model was devel-
oped to analyse the costs and consequences of lifetime treatment
with Rosuvastatin and Atorvastatin. For this purpose, results
from head-to-head, randomised, double-blind trials evaluating
low-density lipoprotein (LDL) changes and from a meta-analy-
sis deﬁning the relationship between LDL levels and fatal and
non-fatal IHD events were combined. Incidence of myocardial
infarction was derived from a nine-year Portuguese observa-
tional study. Death rates due to IHD and other causes were
obtained from ofﬁcial data. Resource use in the treatment of MI
was estimated by a Delphi panel of 8 Portuguese cardiologists
with at least 15 years of clinical practice. Calculation of costs
was done on both the societal and patients’ perspectives. Eligi-
ble population was deﬁned as untreated individuals over 35 years
of age with LDL above 160mg/dl. RESULTS: Rosuvastatin
slightly increases life expectancy: 5.64 days per patient and 8832
years for the eligible population. Although the drug is more
expensive, economic analysis shows that Rosuvastatin is cost
saving. It saves €105 or €57 per patient on the society’s or the
patients’ perspective, respectively. Therefore, Rosuvastatin dom-
inates the alternative having a cost-effectiveness ratio of -€6772
and -€3682 per life year according to the society’s or the
patients’ perspectives. In the 10,000 simulations carried out
Rosuvastatin was always more efﬁcacious than Atorvastatin,
being cost saving in 56.05% of the cases. If the willingness to
pay is higher than €162 (society) or €98 (patients) Rosuvastatin
is cost-effective in all cases. CONCLUSION: Rosuvastatin dom-
inates Atorvastatin in the prevention of IHD in Portugal.
PCV45
THE ECONOMIC ASSESSMENT OF SWITCHING TO DUAL
INHIBITION CHOLESTEROL LOWERING THEARPY 
IN FINLAND
Sintonen H1,Alemao E2, Jousilahti P1, Davies G3, Kujala V4,Yin D2,
Cook J3
1University of Helsinki, Mannerheimintie, Helsinki, Finland; 2Merck and
Co, Whitehouse Station, NJ, USA; 3Merck and Co, Blue Bell, PA, USA;
4MSD Finland, Keilaranta, Espoo, Finland
While treatment guidelines recommend lowering cholesterol 
to target levels, many remain above recommended goal (TC 
>4.5mmol/dl for CHD and diabetic patients). In a clinical trial
patients switched from statin monotherapy to Ezetimibe/Sim-
vastatin (dual inhibition therapy) experienced an additional
27.5% and an 18.8% reduction in LDL-C and TC, respectively.
OBJECTIVE: Assess cost-effectiveness of switching patients to
Ezetimibe/Simvastatin (followed by titration on Ezetimibe/
Simvastatin) versus an atorvastatin dose titration strategy in
CHD/diabetic patients who are not at goal with atorvastatin
monotherapy. METHODS: Previously published decision-ana-
lytic model was used to project lifetime costs and beneﬁts of lipid
therapy. Clinical trial data were used in the model to estimate
TC reductions for different treatment strategies. The effect of TC
reductions on CHD event rates was estimated using Framingham
equations and Finnish statistics on nonCHD-related mortality.
Direct costs of CHD events in Finland [Health 2000 Survey data
at the 2003 price level and also from the literature], Finnish
prices for atorvastatin and Ezetimibe/Simvastatin and age spe-
ciﬁc quality-of-life weights were used to project cost/QALY. The
model was run for a sample of Finnish CHD/diabetic patients
(N = 25) that participated in the Finrisk 2002 study and were
not at TC goal while on therapy with atorvastatin and having
data on all Framingham risk factors. RESULTS: The mean age
of the study sample was 60.4 (SD 7.7) years, 60% male, lipid
proﬁle on atorvastatin TC 5.4 (SD 0.9) mmol/L, HDL-C 1.3 (SD
0.3) mmol/L, triglycerides 1.8 (SD1.1) mmol/L. Switching to 
Ezetimibe/Simvastatin (followed by 11% titration on Ezetimibe/
Simvastatin) compared to atorvastatin titration (11%) is pro-
jected to increase undiscounted life expectancy by 0.75 years for
CHD/diabetic patients with a discounted incremental cost/QALY
of €9172. CONCLUSION: Switching to dual inhibition therapy,
(Ezetimibe/Simvastatin) in CHD/diabetic patients not at goal on
atorvastatin is projected to be a cost-effective alternative to ator-
vastatin titration.
PCV46
COST-ANALYSIS OF HYPERCHOLESTEROLEMIA TREATMENTS
WITHIN THE SLOVAK PHARMACEUTICAL MARKET
Tesar T1, Foltan V1,Tomek D2,Visnansky M1
1Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic;
2Health Insurance fund Apollo, Bratislava, Slovak Republic
OBJECTIVES: The aim of this study was to collect comparable
and reliable data on the lipid lowering therapy in Slovakia during
the period 1996–2004. The special interest was paid to the trend
of the statin and ﬁbrate usages. METHODS: Data of wholesalers
(following ATC/DDD), who are legally obliged provide this
information to the Slovak Institute for Drug Control, was used
for the analysis. The results were expressed in the numbers of
the packages, ﬁnance units (€) and deﬁned daily doses per 1000
inhabitants per day (DID). RESULTS: The collected data showed
large increases in hypolipidemic consumption from 1996 to 2004
in term of DID (in 1996 (4.18), in 2000 (12.79) and in 2004
(31.50)). A signiﬁcant increase in statin consumption (in 1996
(1.97), in 2000 (6.27) and in 2004 (22.33)) and slight increase
in ﬁbrate consumption (in 1996 (3.59), in 2000 (6.38) and in
2004 (9.13)) in term of DID can be seen from this analysis. From
the reimbursement point of view, simvastatin (in 2000 was reim-
bursed at the level of €0.84 per DDD, in 2004 the reimburse-
ment level was at €0.24), ﬂuvastatin (in 2000 was reimbursed at
the level of €0.75 per DDD, in 2004 the reimbursement level was
at €0.47), atorvastatin (in 2000 was reimbursed at the level of
€0.89 per DDD, in 2004 the reimbursement level was at €0.51).
Financial expenditures were for statins (in 1996 (€989,000), in
2000 (€10,335,000) and in 2004 (€13,043,000)) and for ﬁbrates
(in 1996 (€2,743,000), in 2000 (€4,546,000) and in 2004
(€4,478,000)). CONCLUSIONS: Usage of generic drugs for the
treatment of hypercholesterolemia brought about a dramatic
increase in hypolipidemic consumption and the ﬁnancial expen-


PCV44 COST-EFFECTIVENESS OF ROSUVASTATIN IN THE PREVENTION OF ISCHEMIC HEART DISEASE IN PORTUGAL 

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PCV44 COST-EFFECTIVENESS OF ROSUVASTATIN IN THE PREVENTION OF ISCHEMIC HEART DISEASE IN PORTUGAL

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