Considering the cost-effectiveness of statins in family practice in Turkey from a payer perspective

Güvenç Koçkaya¹, Albert Wertheimer², Pınar Daylan Koçkaya³, Ahmet Esen¹

¹Yeditepe Universitesi PEPI, Istanbul, Turkey.
²Temple University, School of Pharmacy, Philadelphia, USA.
³Sisli Etfal Education and Research Hospital, Anesthesia Clinic, Istanbul, Turkey.

DOI: 10.4236/health.2009.14044                

Abstract

The percentage of mortality caused by cardio-vascular events in European Countries and European Union Countries is respectively 49% and 42% of all mortality causes. Our estimates about cardiovascular mortality in Turkey depend on TEKHARF (Hearth Disease and Risk Factors in Turkish Adults) which depended on a 12 year observation. It has been reported that cardio-vascular mortality rates for Turkey in men and women were 0.082% and 0.043% respectively. In Turkey, Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin and Simvastatin are the different alternatives found in the statin market. All stat-ins are reimbursed by insurance companies. The aim of this study is to determine the cost- effectiveness of statins. In conclusion, simvas-tatin and rosuvastatin comprised the optimal two statin alternatives.

Keywords

Hypercholesterolemia; Cardiovascular Disease; Cost-Effectiveness Analysis; Decision Analysis Mode

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Turkish Society of Cardiology [National Cardiology Health Politics], Turkish Society of Cardiology Antalya, (2007) www.tkd.org.tr.
[2]	The Scandinavian Simvastatin Survival Study Group (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet, 344, 1383-9.
[3]	Shepherd, J., Cobbe, S.M., Ford, I., Isles, C.G., Lorimer, A.R., MacFarlane, P.W., et al. (1995) for the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease in men with hypercholes-terolemia. N. Engl. J Med, 333, 1301-7.
[4]	Sacks, F.M., Pfeffer, M.A., Moye, L.A., Rouleau, J.L., Rutherford, J.D., Cole, T.G., et al. (1996) for the Cho-lesterol and Recurrent Events Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with age cholesterol levels. N Engl J Med, 335, 1001-9.
[5]	The Long-Tem Intervention with Pravastatin in Ischae-mic Disease (LIPID) Study Group (1998) Prevention of cardiovascular events and death with pravastatin in pa-tients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med, 339, 1349-57.
[6]	Downs, J.R., Clearfield, M., Weis, S., Whitney, E., Shapiro, D.R., Beere, P.A., et al. (1998) for the AF-CAPS/TexCAPS Research Group. Primary prevention coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/Tex- CAPS. JAMA, 279, 1615-22.
[7]	Heart Protection Study Collaborative Group (2002) MRC /BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high risk individuals: A random-ised plcebo-controlled trial. Lancet, 360, 7-22.
[8]	Serruys, P.W., de Feyter, P., Macaya, C., Kokott, N., Puel, J., Vrolix, M., et al. (2002) Fluvastatin for preven-tion of cardiac events following succesful first percuta-neous coronary intervention. JAMA, 287, 3215-22.
[9]	Jackevicius, C.A., Anderson, G.M., Leiter, L. and Tu, J.V. (2001) Use of the statins in patients after acute myocardial infarction: Does evidence chance practice? Arch Intern Med, 161, 183-8.
[10]	Lemaitre, R.N., Furberg, C.D., Newman, A.B., Hulley, S.B., Gordon, D.J., Gottdiener, J.S., et al. (1998) Time trends in the use of cholesterol-lowering agents in older adults. Arch Intern Med, 158, 1761-1768.
[11]	Turkey Health Ministry Drug Pharmacy General Mana-gement [Drug Price List], Ankara, (2009) www.iegm.gov.tr.
[12]	Turkey Health Ministry [Primary Care Diagnose and Cure Guide], Ankara, (2003) www.saglik.gov.tr.
[13]	Benner, J.S., Smith, T.W., Klingman, D., Tierce, J.C., Mullins, C.D., Pethick, N., et al. (2005) Cost effective-ness of rosuvastatin compared with other statins from a managed care perspective value in health, 8(6), 618-628.
[14]	Social Security Foundation [Budget Application Instruc-tion], Ankara, (2009) www.bumko.org.tr.
[15]	Olsson, A.G., Istad, H., Luurila, O., Ose, L., Stender, S., Tuomilehto, J., et al. (2002) Rosuvastatin Investigators Group. Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholes-terolemia, Am Heart J., 144(6), 1044-51.
[16]	Blasetto, J.W., Stein, E.A., Brown, W.V., Chitra, R. and Raza, A. (2003) Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholes-terolemic patients and in special population groups, Am J Cardiol., 91(5A), 3C-10C.
[17]	Boyac?, B. (2008) Cardiometabolic risk management: Statins in the prevention of cardiovascular events, Tur- kiye Klinikleri J Med Sci, 28(6 Suppl 1):S, 44-7.