Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD

Results of the Study of Heart and Renal Protection (SHARP)

Borislava Mihaylova, Iryna Schlackow, William Herrington, Jingky Lozano-Kühne, Seamus Kent, Joanthan Emberson, Christina Reith, Richard Haynes, Alan Cass, Jonathan Craig, Alastair Gray, Rory Collins, Martin Landray, Colin Baigent

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown.

    Study Design: Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial.

    Setting & Population: 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10%; medium, 10%-<20%; or high, ?20%) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy).

    Model, Perspective, & Timeline: Assessment during SHARP follow-up from the UK perspective; long-term projections.

    Intervention: Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day).

    Outcomes: Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained.

    Results: In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost.

    Limitations: High-intensity statin-alone regimens were not studied in SHARP.

    Conclusions: Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD.
    Original languageEnglish
    Pages (from-to)576-584
    Number of pages9
    JournalAmerican Journal of Kidney Diseases
    Volume67
    Issue number4
    DOIs
    Publication statusPublished - Apr 2016

    Fingerprint

    Simvastatin
    Chronic Renal Insufficiency
    Cost-Benefit Analysis
    Kidney
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Quality-Adjusted Life Years
    Dialysis
    Costs and Cost Analysis
    Ezetimibe
    Hospital Costs
    LDL Lipoproteins
    Health Care Costs
    LDL Cholesterol
    Blood Vessels
    Therapeutics
    Randomized Controlled Trials
    Placebos

    Cite this

    Mihaylova, Borislava ; Schlackow, Iryna ; Herrington, William ; Lozano-Kühne, Jingky ; Kent, Seamus ; Emberson, Joanthan ; Reith, Christina ; Haynes, Richard ; Cass, Alan ; Craig, Jonathan ; Gray, Alastair ; Collins, Rory ; Landray, Martin ; Baigent, Colin. / Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP). In: American Journal of Kidney Diseases. 2016 ; Vol. 67, No. 4. pp. 576-584.
    @article{eacf39a93749410ab16564c30b950781,
    title = "Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP)",
    abstract = "Background: Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design: Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population: 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10{\%}; medium, 10{\%}-<20{\%}; or high, ?20{\%}) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy). Model, Perspective, & Timeline: Assessment during SHARP follow-up from the UK perspective; long-term projections. Intervention: Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes: Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results: In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20{\%} (95{\%} CI, 6{\%}-32{\%}) and in the costs of vascular hospital episodes of 17{\%} (95{\%} CI, 4{\%}-28{\%}) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations: High-intensity statin-alone regimens were not studied in SHARP. Conclusions: Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD.",
    author = "Borislava Mihaylova and Iryna Schlackow and William Herrington and Jingky Lozano-K{\~A}¼hne and Seamus Kent and Joanthan Emberson and Christina Reith and Richard Haynes and Alan Cass and Jonathan Craig and Alastair Gray and Rory Collins and Martin Landray and Colin Baigent",
    year = "2016",
    month = "4",
    doi = "10.1053/j.ajkd.2015.09.020",
    language = "English",
    volume = "67",
    pages = "576--584",
    journal = "American Journal of Kidney Diseases",
    issn = "0272-6386",
    publisher = "W.B. Saunders",
    number = "4",

    }

    Mihaylova, B, Schlackow, I, Herrington, W, Lozano-Kühne, J, Kent, S, Emberson, J, Reith, C, Haynes, R, Cass, A, Craig, J, Gray, A, Collins, R, Landray, M & Baigent, C 2016, 'Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP)', American Journal of Kidney Diseases, vol. 67, no. 4, pp. 576-584. https://doi.org/10.1053/j.ajkd.2015.09.020

    Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP). / Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Joanthan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin; Baigent, Colin.

    In: American Journal of Kidney Diseases, Vol. 67, No. 4, 04.2016, p. 576-584.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD

    T2 - Results of the Study of Heart and Renal Protection (SHARP)

    AU - Mihaylova, Borislava

    AU - Schlackow, Iryna

    AU - Herrington, William

    AU - Lozano-Kühne, Jingky

    AU - Kent, Seamus

    AU - Emberson, Joanthan

    AU - Reith, Christina

    AU - Haynes, Richard

    AU - Cass, Alan

    AU - Craig, Jonathan

    AU - Gray, Alastair

    AU - Collins, Rory

    AU - Landray, Martin

    AU - Baigent, Colin

    PY - 2016/4

    Y1 - 2016/4

    N2 - Background: Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design: Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population: 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10%; medium, 10%-<20%; or high, ?20%) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy). Model, Perspective, & Timeline: Assessment during SHARP follow-up from the UK perspective; long-term projections. Intervention: Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes: Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results: In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations: High-intensity statin-alone regimens were not studied in SHARP. Conclusions: Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD.

    AB - Background: Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design: Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population: 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10%; medium, 10%-<20%; or high, ?20%) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy). Model, Perspective, & Timeline: Assessment during SHARP follow-up from the UK perspective; long-term projections. Intervention: Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes: Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results: In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations: High-intensity statin-alone regimens were not studied in SHARP. Conclusions: Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD.

    UR - http://www.scopus.com/inward/record.url?scp=84947346748&partnerID=8YFLogxK

    U2 - 10.1053/j.ajkd.2015.09.020

    DO - 10.1053/j.ajkd.2015.09.020

    M3 - Article

    VL - 67

    SP - 576

    EP - 584

    JO - American Journal of Kidney Diseases

    JF - American Journal of Kidney Diseases

    SN - 0272-6386

    IS - 4

    ER -