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Cost-effectiveness of Combined Statin-Resin Therapy
- Dennis L. Sprecher, MD; and
- Leonard Jokubaitis, MD
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IN RESPONSE:
The comments of Dr. Katz regarding cost-effectiveness and its value in reports on new drugs are well advised. However, his suggestion that pharmaceutical company sponsorship of this clinical trial was the rationale for nondisclosure of cost is unfounded. Our manuscript [1] was submitted to Annals before the Food and Drug Administration approved fluvastatin for clinical use. The determination of pharmaceutical pricing is a labile phenomenon, and the specific price of fluvastatin was not available to the authors at the time of submission.
Table 1 provides a simple cost-effectiveness comparison of various therapeutic regimens, based on currently available pricing data and previously observed reductions [1-4] in low-density lipoprotein (LDL) cholesterol levels.
An analysis of cost per 1% reductin in LDL levels, given that the least expensive tablet at any dose of hemoglobin CoA reductase inhibitors other than fluvastatin is more than $1.60, suggests that fluvastatin is the most cost-effective monotherapy. For a reduction in LDL levels of approximately 30%, the combination of fluvastatin and cholestyramine was more cost-effective than higher doses of other reductase-inhibitor monotherapy.
Note that the efficacy of a 40-mg dose of fluvastatin (average wholesale price, $1.14) in general hypercholesterolemic patients has yet to be reported (24% mean LDL reduction in heterozygous familial hypercholesterolemia [5]), that the 10-mg formulation of fluvastatin used in our study is not commercially available and therefore not displayed, and that an LDL reduction of 22% was observed with fluvastatin (20 mg) in a larger randomized trial [5]. In addition, the selection of a particular monotherapy or combination regimen must be tailored to a particular patient, including his or her lipoprotein profile and preexisting conditions or therapy. A rigorous cost-effectiveness assessment would also warrant the factoring of indirect costs (for example, care associated with adverse effects of therapy).
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
