Article

Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: Results from the Collaborative Atorvastatin Diabetes Study (CARDS)

LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Diabetologia (Impact Factor: 6.67). 05/2007; 50(4):733-40. DOI: 10.1007/s00125-006-0561-4
Source: PubMed

ABSTRACT

We estimated the cost-effectiveness of atorvastatin treatment in the primary prevention of cardiovascular disease in patients with type 2 diabetes using data from the Collaborative Atorvastatin Diabetes Study (CARDS).
A total of 2,838 patients, who were aged 40 to 75 years and had type 2 diabetes without a documented history of cardiovascular disease and without elevated LDL-cholesterol, were recruited from 32 centres in the UK and Ireland and randomly allocated to atorvastatin 10 mg daily (n = 1,428) or placebo (n = 1,410). These subjects were followed-up for a median period of 3.9 years. Direct treatment costs and effectiveness were analysed to provide estimates of cost per endpoint-free year over the trial period for alternative definitions of endpoint, and of cost per life-year gained and cost per quality-adjusted life-year (QALY) gained over a patient's lifetime.
Over the trial period, the incremental cost-effectiveness ratio (ICER) was estimated to be 7,608 pounds per year free of any CARDS primary endpoint; the ICER was calculated to be 4,896 pounds per year free of any cardiovascular endpoint and 4,120 pounds per year free of any study endpoint. Over lifetime, the incremental cost per life-year gained was 5,107 pounds and the cost per QALY was 6,471 pounds (costs and benefits both discounted at 3.5%).
Primary prevention of cardiovascular disease with atorvastatin is a cost-effective intervention in patients with type 2 diabetes, with the ICER for this intervention falling within the current acceptance threshold ( 20,000 pounds per QALY) specified by the National Institute for Health and Clinical Excellence (NICE).

Download full-text

Full-text

Available from: Andrew Neil, Dec 19, 2013
  • Source
    • "The adult treatment panel III on national cholesterol control program issued evidence based guidelines on cholesterol management (Expert, 2001). In high risk persons for CAD like diabetes the recommended LDL-C goal is < 100mg/dl but when the risk is very high LDL-C goal is <70mg/dl (The DALI study, 2001; Raikou 2007). Due to the histopathological similarity between diabetic retinopathy and CAD, atorvastatin could also have a role to play in diabetic retinopathy with normal lipid profile. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Lipid-lowering drugs preserve vision and reduce the risk of hard exudates in clinically-significant macular edema(CSME) in diabetics with an abnormal lipid profile. But their role in reducing CSME in diabetics with a normal lipid profile is not yet known. Objective: To evaluate the role of atorvastatin in CSME in diabetics with a normal lipid profile. Materials and methods: A prospective, randomized clinical trial was carried out. Thirty CSME patients with a normal lipid profile were randomly divided into Group A and B. Atorvastatin had been started in Group A four weeks prior to laser treatement. The main outcome measures were any improvement or deterioration in visual acuity and macular edema and hard exudates at six months follow-up. Statistics: Both the groups were compared using unpaired t test for quantitative parameters and chi-square test for qualitative parameters. A p value of less than 0.05 was taken as significant. Results: Visual acuity, macular edema and hard exudates resolution was not significantly different in the two groups (P = 0.14, 0.62, 0.39 respectively). Conclusion: Atorvastatin does not affect treatment outcome in CSME with a normal lipid profile over a short term follow-up.
    Full-text · Article · Feb 2012 · Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH
  • Source
    • "As with much other data in pediatric DM, cost-analysis data does not exist for the treatment of dyslipidemia beginning in childhood. Adult literature shows that several European cost-effectiveness studies based on the “Collaborative Atorvastatin Diabetes Study” have determined atorvastatin use in adults to be cost–effective to various degrees depending on the country in which the drug is to be used when compared to no treatment in the prevention of CVD (Raikou et al., 2007; Lafuma et al., 2008; Annemans et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular disease (CVD) is a well-known complication of diabetes mellitus (DM), and patients with DM are at an increased risk for early onset of CVD. Hyperglycemia is believed to be the primary mediator in premature development of atherosclerosis in patients with DM, but there are also derangements in cholesterol levels and inflammatory markers beyond the explanation of hyperglycemia. Although clinicians often screen for dyslipidemia as part of routine care for children and adolescents with DM, many do not feel comfortable treating this condition. Multiple guidelines exist to help clinicians with the prevention, screening, and treatment of CVD risk factors in pediatric patients with DM, but the guidelines do not always agree on screening intervals or medical treatment. Furthermore, the cost-effectiveness of medication use in this population has not been established. Research has advanced our understanding of the role of other biomarkers and radiologic studies of CVD risk, but these studies do not currently have a place in routine clinical practice. It is evident that the increased CVD risk in pediatric patients with DM is complex in origin and the optimal approach to managing dyslipidemia remains unclear. Therefore, an algorithm designed at the University of North Carolina (UNC), Division of Pediatric Endocrinology, is presented to help guide clinicians through screening and treatment of dyslipidemia in youth with DM.
    Full-text · Article · Oct 2011 · Frontiers in Endocrinology
  • Source
    • "The French Transparency Commission estimated this target population to be approximately 600 000 in France [5]. The costeffectiveness of atorvastatin has already been studied in Spain [6] and in the United Kingdom [7], but healthcare systems and medical expenses vary widely between countries . Therefore, the objective of the present study was to estimate its cost-effectiveness in the primary prevention of cardiac events in a French diabetic population without elevated LDL cholesterol. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We estimated the cost-effectiveness of atorvastatin in the primary prevention of cardiovascular events in patients with type 2 diabetes using data from the Collaborative AtoRvastatin Diabetes Study (CARDS). A total of 2838 patients aged 40-75 years with type 2 diabetes and no documented history of cardiovascular disease and without elevated low-density-lipoprotein cholesterol were recruited in the UK and in Ireland. Patients were randomly allocated to atorvastatin 10mg daily (n=1428) or placebo (n=1410) and were followed up for a median of 3.9 years. Direct treatment costs and effectiveness were analysed to provide estimates of cost per event avoided and cost per life-year gained over the trial period and over a patient's lifetime. The incremental cost-effectiveness ratio over the trial period was estimated to be Euro 3862 per clinical event avoided. Over the patient's lifetime, the incremental cost per life-year gained was Euro 2506 when considering cardiovascular deaths, and Euro 1418 per year when considering all-cause death. Primary prevention of cardiovascular disease with atorvastatin is cost-effective in patients with type 2 diabetes, with the incremental cost-effectiveness ratio for this intervention falling within the current acceptance threshold.
    Full-text · Article · May 2008 · Archives of Cardiovascular Diseases
Show more