Comparison of efficacy and cost among lipid-lowering agents in patients with primary hypercholesterolemia

OBJECTIVE: To compare efficacy and cost of lipid-lowering agents in patients with primary hypercholesterolemia. DESIGN: A meta-analysis was conducted to determine estimates of efficacy for lipid-lowering agents. Efficacy was defined as the change in the ratio of total cholesterol:high density lipoprotein (HDL) induced by treatment. This ratio was selected because of its good predictive value for the risk of coronary disease. Lipid-lowering agents were grouped into three categories according to the decrease in the total cholesterol:HDL ratio. Acquisition prices for drugs were obtained from the Quebec provincial drug formulary. An analysis determined which drugs in each category 'purchased' the greatest decrease in ratio for the lowest cost. SETTING: Clinical trial study centres. PATIENTS: The population analyzed had a mean baseline total cholesterol:HDL ratio of 7.3, an average age of 50.5 years and mean proportion of men of 62.5%. INTERVENTIONS: Twelve lipid-lowering therapies at various doses were investigated. RESULTS: Drugs that were more recently introduced had the greatest effect on the total cholesterol:HDL ratio. A direct dose-effect relationship was not evident, although there was a trend in this direction. In each of the three categories, there was wide range of cost, suggesting that the same effect is available at a broad range of prices. The drugs with the greatest effect on the ratio at the low-est cost were fluvastatin 60 mg/day, fenofibrate (micronized) 200 mg/day and simvastatin 20 mg/day. CONCLUSION: These results can be useful for clinicians in the selection of agents that achieve a specified goal of therapy at the lowest cost.