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Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.

Publication ,  Journal Article
Mark, DB; Knight, JD; Cowper, PA; Davidson-Ray, L; Anstrom, KJ
Published in: Am Heart J
October 2008

BACKGROUND: In 10,001 patients with stable coronary artery disease (CAD) enrolled in the Treating to New Targets (TNT) trial, 80 mg/d of atorvastatin (high-dose regimen) reduced the composite primary end point of death from CAD, nonfatal myocardial infarction, resuscitation from cardiac arrest, or stroke by 22% relative to 10 mg/d (low-dose regimen). METHODS: We performed an economic analysis of this trial from the US perspective using hospital bills and Medicare physician fees to estimate costs for cardiovascular hospitalizations in all US patients (n = 5,308). Atorvastatin costs were assigned using a discounted average wholesale price. Cost-effectiveness was calculated as the within-trial incremental cost required to prevent one primary end point event with high-dose atorvastatin. RESULTS: During a mean 4.9-year follow-up, the high-dose arm had fewer potential end point cardiovascular hospitalizations (35% vs 41%, P < .001) and revascularization procedures (16% vs 22%, P < .001). The high-dose regimen was $1 per day more expensive. At the end of 5 years, cumulative incremental cost for the high-dose arm was $252 (95% CI-$722 to +$1,276). With an absolute reduction in the primary end point of 2.8 per 100 treated with the high-dose regimen, the cost to prevent one additional primary end point event was $8,964. CONCLUSION: High-dose atorvastatin treatment of 5 years had only a small net incremental cost because of reduced complications and procedures. The cost to prevent one additional primary end point event with high-dose therapy was similar to that for drug-eluting stents versus bare metal stents in stable CAD and for early invasive versus early conservative therapy in acute coronary syndromes.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2008

Volume

156

Issue

4

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • United States
  • Pyrroles
  • Prospective Studies
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Middle Aged
  • Medicare
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
 

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Mark, D. B., Knight, J. D., Cowper, P. A., Davidson-Ray, L., & Anstrom, K. J. (2008). Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial. Am Heart J, 156(4), 698–705. https://doi.org/10.1016/j.ahj.2008.05.032
Mark, Daniel B., J David Knight, Patricia A. Cowper, Linda Davidson-Ray, and Kevin J. Anstrom. “Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.Am Heart J 156, no. 4 (October 2008): 698–705. https://doi.org/10.1016/j.ahj.2008.05.032.
Mark, Daniel B., et al. “Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.Am Heart J, vol. 156, no. 4, Oct. 2008, pp. 698–705. Pubmed, doi:10.1016/j.ahj.2008.05.032.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2008

Volume

156

Issue

4

Start / End Page

698 / 705

Location

United States

Related Subject Headings

  • United States
  • Pyrroles
  • Prospective Studies
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Middle Aged
  • Medicare
  • Male
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans