Abstract

JACC

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TCTAP A-069

Cost-Effectiveness Analysis of High-Potency Versus Low-Potency Statins for Reducing Mortality in Coronary Artery Disease Patients on Dual Antiplatelet Therapy Post Percutaneous Coronary Intervention.

By Shaban Mohammed, Abdul Rahman Arabi, Dina Abushanab, Sawsan Almukdad, Rania Abdel-Latif, Ayman El-Menyar, Salah Arafa, Ihsan Rafie, Awad Alqahtani, Moza Al Hail, Nidal Asaad, Jassim Al Suwaidi

Presenter

Shaban Mohammed

Authors

Shaban Mohammed1, Abdul Rahman Arabi2, Dina Abushanab1, Sawsan Almukdad3, Rania Abdel-Latif4, Ayman El-Menyar1, Salah Arafa2, Ihsan Rafie2, Awad Alqahtani2, Moza Al Hail1, Nidal Asaad2, Jassim Al Suwaidi2

Affiliation

Hamad Medical Corporation, Qatar1, HMC Heart Hospital, Qatar2, Qatar University, Qatar3, Minia University, Egypt4
View Study Report
TCTAP A-069
Pharmacology/Pharmacotherapy

Cost-Effectiveness Analysis of High-Potency Versus Low-Potency Statins for Reducing Mortality in Coronary Artery Disease Patients on Dual Antiplatelet Therapy Post Percutaneous Coronary Intervention.

Shaban Mohammed1, Abdul Rahman Arabi2, Dina Abushanab1, Sawsan Almukdad3, Rania Abdel-Latif4, Ayman El-Menyar1, Salah Arafa2, Ihsan Rafie2, Awad Alqahtani2, Moza Al Hail1, Nidal Asaad2, Jassim Al Suwaidi2

Hamad Medical Corporation, Qatar1, HMC Heart Hospital, Qatar2, Qatar University, Qatar3, Minia University, Egypt4

Background

Statins are usually prescribed to patients with coronary artery disease (CAD) post percutaneous coronary intervention (PCI) to reduce cardiovascular events and repeat revascularization. In those same patients, an evidence of a reduced mortality with the use of statins has been provided in literature.  Here, however, evidence of the benefit of high-potency statins against low-potency statins is lacking in Middle east. Objective:First-time cost-effectiveness evaluation of high-potency versus low-potency statins for reducing mortality in CAD patients on DAPT post PCI.

Methods

A decision analytic model, from the perspective of the hospital, was constructed to follow possible consequences of using high-potency statins (atorvastatin 40 mg and rosuvastatin 20 mg) versus low-potency statins (atorvastatin 20 mg, pravastatin 40 mg, rosuvastatin 10 mg), in 18 years of age or older CAD patients, receiving combination therapy of aspirin and clopidogrel post PCI. Both statins and clopidogrel were administered for one year post PCI. The primary end points were the first-year and long-term survival rates among patients, as well as the overall direct medical cost of therapy. The model inputs were based on 550 retrospectively recruited patients between October 2012 to March 2013 in Heart Hospital, a tertiary cardiac center in Qatar, who were then individually followed up until 2019.  Survival analysis was performed using log rank Kaplan Meier. Sensitivity analyses via Monte Carlo simulation enhanced robustness and the generalizability of study results.

Results

While high-potency statins did not significantly enhance the long-term survival of patients, 56 versus 55 months (p-value 0.72), they did significantly reduce the first-year mortality, 1.6% versus 5.6% (p-value 0.008). Based on this, in addition to a calculated overall cost-saving of $US 3,081 in favor of the high-potency statins per patient, the high-potency statins dominates the low-potency ones against both first-year and long-term survival outcomes. Based on multivariate uncertainty analysis, the reported dominance of high-potency statins was maintained in 90% of simulated cases.

Conclusion

The use of high-potency statins significantly reduces first-year mortality with DAP post PCI in CAD patients, compared to low-potency statins, and is a cost-effective approach for enhancing the patients’ first-year and long-term survival outcomes. 

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