How Cost-Effective Is the Treatment of Dyslipidemia in Patients With Diabetes but Without Cardiovascular Disease?

  1. Steven A. Grover, MD, MPA, FRCPC,
  2. Louis Coupal, MSC,
  3. Hanna Zowall, MSC,
  4. Charles M. Alexander, MD, FACP, FACE,
  5. Thomas W. Weiss, DRPH and
  6. Daniel R.J. Gomes, MSC
  1. From the Centre for the Analysis of Cost-Effective Care and the Divisions of General Internal Medicine and Clinical Epidemiology (S.A.G., L.C., H.Z.), the Montreal General Hospital; the Department of Medicine and the Department of Epidemiology and Biostatistics (S.A.G.), McGill University, Montreal, Quebec, Canada; and Merck & Co. (T.W.W., D.R.J.G., C.M.A.), Whitehouse Station, New Jersey and West Point, Pennsylvania.
  1. Address correspondence and reprint requests to Steven A. Grover, MD, MPA, FRCPC, Division of Clinical Epidemiology, The Montreal General Hospital, 1650 Cedar Ave., Montreal, PQ H3G 1A4, Canada. E-mail: mdev{at}musica.mcgill.ca .

Abstract

OBJECTIVE— Epidemiological studies have shown that the risk of myocardial infarction (MI) in diabetic patients without cardiovascular disease (CVD) is comparable to the risk of MI in patients with CVD. We used a validated Markov model to compare the long-term costs and benefits of treating dyslipidemia in diabetic patients without CVD versus treating CVD patients without diabetes in the U.S. The generalizability and robustness of these results were also compared across six other countries (Canada, France, Germany, Italy, Spain, and the U.K.).

RESEARCH DESIGN AND METHODS— With use of the Cardiovascular Disease Life Expectancy Model, cost effectiveness simulations of simvastatin treatment were performed for men and women who were 40-70 years of age and had dyslipidemia. We forecast the long-term risk reduction in CVD events after treatment. On the basis of the Scandinavian Simvastatin Survival Study results, we assumed a 35% reduction in LDL cholesterol and an 8% rise in HDL cholesterol.

RESULTS— In the U.S., treatment with simvastatin for CVD patients without diabetes was cost-effective, with estimates ranging from $8,799 to $21,628 per year of life saved (YOLS). Among diabetic individuals without CVD, lipid therapy also appeared to be cost-effective, with estimates ranging from $5,063 to $23,792 per YOLS. In the other countries studied, the cost effectiveness of treating diabetes in the absence of CVD was comparable to the cost effectiveness of treating CVD in the absence of diabetes.

CONCLUSIONS— Among diabetic men and women who do not have CVD, lipid therapy is likely to be as effective and cost-effective as treating nondiabetic individuals with CVD.

Footnotes

  • S.A.G. is a senior research scholar (Chercheur-boursier) supported by the Fonds de la Recherche en Santé du Québec. Support for this study was provided by Merck & Co., Inc.

  • Abbreviations: 4S, Scandinavian Simvastatin Survival Study; CVD, cardiovascular disease; MI, myocardial infarction; YOLS, year of life saved.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted September 28, 2000.
    • Received April 11, 2000.
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