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The subject under consideration is the treatment of high blood cholesterol in Adults. Statins (reductase inhibitors HMG-CoA) are widely applied for treatment of hypercholesterolemia. Their inhibitory action is based on agonize in relation to reductase HMG-CoA, thus they reduce the LDL concentration to greater extend than other preparations lowering the level of cholesterol. Besides they normalize the concentration of triglycerides of the patients with hypercholesterolemia. Statins are easy to withstand, and their application is characterized by authentic safety parameters. Clinical researches of patients with coronary heart disease and without it, with high and normal level of cholesterol invariably showed that statins reduce the relative risk of heavy complications of coronary heart disease approximately by 30 %, thus the absolute positive effect is more strongly expressed in the group of patients with the raised initial risk.
Such result is explained by the positive action on plasma lipoproteins, on the endothelium function, on the structure and stability of plagues, and also by the suppression of thrombosis and inflammation. The mechanisms, which are not dependent on LDL decrease can play the important role in achievement of positive clinical effect at use of statins, therefore, probably, doctors begin to consider them top be not only the medical products intended for reduction of lipids level, but also antiatherogenic drugs. Lovastatin and simvastatin are obtained by means of a mushroom fermentation. But they are very expensive that is why the necessity of comparing the cost-effectiveness of this two preparations by means of decision-analytic model. Cost effectiveness analysis makes it easy to compare two or more drug therapies, which have the same treatment purpose but different degrees of effectiveness. The benefits are calculated in the number of saved years of life whereas expenses are presented in monetary terms.
If to take into account the quality of life, the result converts to price per quality adjusted year of life. Decision makers determine how much additional benefit can bring the additional expenses used for statins and in comparison to other preparations they are rather cost effective. After the creation of decision-analytic model, scientists chose simvastatin to be included in the model because by that time it had true clinical outcomes data. Also publication of 4 S and HATS studies supported its inclusion in the model. This model included all the necessary aspects: three separate model for different cases, analysis of side affects frequency. The model defined the effectiveness rate as a patient achieving LDL and HDL goals and not experiencing the significant adverse event.
Health care resource unit and their respective cost were estimated for each pathway in the model. Cost effectiveness was calculated by determining the direct-medical costs to achieve a successfully treated patient. The estimation of risk is also important for allocation of persons with small probability of CHD attacks because their expenses for statins therapy are unjustified. The medicine is concerned about the fact that the statins expenditure rate is growing and this issue is subject to pharmacoeconomic review. In order to choose the people to involve into the analysis the scientists took the data files that were applied to ATP guidelines. Patients with CHD or CHD risk equivalent were assigned an LDL goal of < 100 mg / d L.
Patients with multiple risk factors and an estimated risk? 20 % were assigned an LDL goal of < 130 mg / d L. Patients with no or one risk factors were assigned an LDL goal of < 160 mg / d L. Patients were included in the model only if they had LDL levels above their calculated target goal. Cost-sensitivity analyses were conducted by decreasing the medication costs by 25 % for the most costly treatment strategy. In addition sensitivity analyses were conducted to estimate cost changes over a one-year study horizon. In the one year sensitivity analyses it was assumed that there was one additional minor problem physician visit and 365 days of drug therapy based upon the dose of each pathway.
As a result it was determined that simvastatin had the highest clinical success rate in achieving both LDL and HDL goals in patients that required a LDL level. < 160 mg / d L and HDL? 40 mg / d L. The estimated total direct medical cost to use simvastatin was approximately twice that of lovastatin. Based on this estimates the incremental cost effectiveness ration for each additional patient to reach LDL and HDL goals without an adverse event with simvastatin was $ 4, 427 when compared with lovastatin In some years, due to scientific researches, we will learn whether statins are effective at acute coronary syndromes: in themselves or as the main component of medicinal therapy. Moreover at patients with stable CHD results of such therapy and revascularization will be compared.
Really, recent research has shown that at patients with stable CHD statins in high dozes is as effective in reduction of frequency of heavy displays of the given disease, as angioplasty in a combination to usual leaving. Other important direction of researches will consist in an estimation of value of statins therapy for prevention of an insult at patients with high risk of cerebrovascular pathologies...
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Research essay sample on Coronary Heart Disease Cost Effectiveness
