Análise de custo-efetividade da Sinvastatina versus Atorvastatina na prevenção secundária de eventos cardiovasculares no Sistema Único de Saúde brasileiro

Araujo, Denizar Vianna
Souza, Camila Pepe Ribeiro de
Bahia, Luciana Ribeiro
Rey, Helena Cramer Veiga
Santos Junior, Braulio
Tura, Bernardo Rangel
Berwanger, Otavio
Buehler, Anna Maria
Silva, Marcus Tolentino
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Value in Health
Objective The objective of this study is to perform an economic evaluation analyzing the treatment with atorvastatin and simvastatin in comparison to placebo treatment, within the Brazilian Public Healthcare System (SUS) scenario, for patients with high risk of cardiovascular disease; analyzing if the additional cost related to statin treatment is justified by the clinical benefits expected, in terms of cardiovascular event and mortality reduction. Methods Cardiovascular event risk and mortality risk were used as outcomes. Statin efficacy at LDL-c and cardiovascular events levels lowering data was obtained from a systematic review of literature. A decision analytic model was developed to perform a cost-effectiveness analysis comparing atorvastatin 10mg/day and simvastatin 40mg/day to placebo treatment in patients with dyslipidemia in Brazil. The target population of this study was a hypothetic cohort of men and women with a mean age of 50 years old and high risk of cardiovascular disease. The model includes only direct costs obtained from Ambulatory and Hospital Information System and Price Database of Brazilian Ministry of Health. The comparative cost-effectiveness analysis itself was done through Excel spreadsheets covering a 5 -years time horizon. Results The result shows that atorvastatin 10mg/day in comparison to placebo has higher cost with higher effectiveness in the time horizon of 5 years (Incremental Cost Effectiveness Ratio of R$ 433.065,05 per life year gained). In this scenario atorvastatin is not cost effective in comparison to placebo. The simvastatin 40mg/day appears to be a strategy with lower cost and higher effectiveness in comparison to placebo, in the time horizon analyzed (5 years). In the multivariate probabilistic sensitivity analysis, simvastatin showed 53% of the results in the quadrant with greater effectiveness and lower cost. Conclusions This study is an important tool for public decision makers. The study can be used in the decision process of increasing cardiovascular disease treatment access with budgetary sustainability for Ministry of Health. In comparison to placebo, the results show that sinvastatin is a cost saving strategy while atorvastatin is not cost effective.
Statin therapy, Secondary prevention, Cost-effectiveness, Cholesterol lowering, Cardiovascular disease
Araujo DV, Souza CPR, Bahia LR, Rey HCV, Santos Junior B, Tura BR, Berwanger O, Buehler AM, Silva MT. Análise de Custo-Efetividade da Sinvastatina versus Atorvastatina na Prevenção Secundária de Eventos Cardiovasculares no Sistema Único de Saúde Brasileiro. Value Health. 2011;14(5):S29-S32. Doi: