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Lovastatin in pravastatin comparative trial: Cost-effectiveness
Cost Analysis
Pravastatin Lovastatin Pravastatin Lovastatin Pravastatin Lovastatln
10 20 20 40 40 80
Price of 30-Day SUPPlY
Percentage of Tota I Cholesterol Lowering
Cost per Percentage of Total Cholesterol Lowering
Percentage of LDL Cholesterol Lowering
Cost per Percentage of LDL Cholesterol Lowering
49.18
-13
57.59
-20
3.78 2.87 3.24 4.51 5.46 7.40
-19 -28 -25 -33 -27 -39
2.59 2.05 2.08 3.14 3.84 5.31
-16
51.91
-23 -19 -28
103.65 103.82 207.31
LDL = low-density lipoprotein.
Lovastatin
Versus
Pravastatin
in Reducing
Total and LDL Cholesterol
Lipid/ Lipoprotein
Lovastatin
Total cholesterol LDL cholesterol
-20 -28
(10) (15)
Pravastatin -16 -24
(12) (17)
I
Mean % Change (40 mg/day)
Mean % Change (20 mg/day)
Pravastatln
p Value
(11)
-18 (13)
(15)
-26
p Value
Lovastatin
-23 -32
0.002
(17)
LDL = low-density lipoprotem
than is lovastatin, since lovastatin should be taken with food. Additionally, the Expanded Clinical Evaluation of Lovastatin (EXCEL) study has shown that the efficacy of 40 mg of lovastatin can be increased by 13% by dividing the dosage, rather than giving it once a day.2 There is no difference in the efficacy of pravastatin when the same total dosage is given twice or once daily. In contrast to the conclusions of the Lovastatin Pravastatin Study Group, we found that patients at our institution could be successfully dose-reduced by about 50% when switched from lovastatin to pravastatin. Our real world results are supported by 21 double-blind, doubleplacebo, randomized comparison that demonstrated that the differences in mean reductions of total and LDL cholesterol at 8 weeks were not statistically significant between 20 mg of lovastatin given once daily with the evening meal and 10 mg of pravastatin given at bedtime.’ Our results are significant considering the ever increasing need for cost-effective ways to maintain optimal patient care. Lisa 6. Korman.
PII-D
Newington, Cotkcticut 25 May 1993 1. The Lovastatm Pravastatin Study Group. A multicenter comparative trial of lovastarin and pravastatin
in the treatmentof hypercholesterolemia. 4nr .I Cardid 1993:71:81~~81S. 2. Bradford RH, Shear CL, Chremos AN. Dujovne C, Downton M, Franklin FA, Gould AL, Hesney M, Higgms T, Hurley DP, Langendorfer A, Nash DT, Pool JL, Schnaper H. Expanded Clinical Evaluation of Lovastatin (EXCEL) study resulrs. Amh Intrr-n Med 1991:151:4.~9. 3. McPherson R, Bedard J. Connelly P, Cumew G. Davignon J, Echenberg D, Lavin P, Later L, Lenis J, McQueen M, Montigny M, Munoz C, O’Leary T, Ooi T, Rouleau I, Space D, Tan M, Theroux P. Comparison of the shon-term efficacy and tolerability of lovastatin and pravastatin in the management of priC/in Ther- 1992; 14: mary hypercholesterolemia. 276-29 I.
Lovastatin in Pravastatin Comparative Trial: Cost-Effectiveness In the April 1993 issue of the AJC, the Lovastatin Pravastatin Study Group’ compared the effectiveness of lovastatin and pravastatin in a double-blinded trial. Their final discussion suggests that lovastatin is more effective than is pravastatin across dosing ranges. Unfortunately, I believe that a cost analysis of cholesterol-lowering shows that pravastatin is more effective at the higher dose ranges. The attached table shows a cost breakdown for each percent of cholesterol and lowdensity lipoprotein (LDL) lowering.2 As arranged in the table, one can see the differences in cost per the percentage of total and LDL cholesterol over a 30-day period. This would
suggest that the potency difference is of minimal importance when costeffectiveness is determined. At the lowest dose range, lovastatin would seem to have a cost advantage; however, at higher dose ranges, pravastatin seems to have the more favorable cost. Other analyses of the effects of pravastatin on LDL cholesterol have shown more dramatic results: 22.4, 32.4, and 34.1% at the IO,20 and 40 mg/day doses, respectively.3 If these factors were used in the cost analysis, the cost-effectiveness of pravastatin would be more dramatic. Sam Farbstein,
MD
Chicago Ridge, Illinois 2 July 1993 1. The Lovastatin Pravastarin Study Group. A multicenter comparative trial on lovastatin and pravastatin in the treatment of hypercholesverolemia. Am .I Cardial 1993:71:810-815. 2. MEDLSPAN’s
PrescriptionPricingGuide@,Nation-
al Average Wholesale Prices (AWP), Medispan Inc., March 1993. 3. Jones PH, Farmer JA, Crasman MD, McKenney JM. Wright JT, Proctor JD, Berkson DM, Famham DJ, Wolfson PM, Golfer HT, Rockley CE, Sigmund WR, Schlant RC, Are&erg D, McGovern ME. Oncedaily pravaatatin in patients with primary hyperchole\terolemia: a dose response study. Cli~l C~I&I/ 1991;14:14~151.
Reply: All 3 letters above address issues raised by our study, conceming the comparative lipid-altering efficacy and cost of lovastatin and
READERS’ COMMENTS
417
Pravastatin Lovastatin Pravastatin Lovastatin Pravastatin Lovastatln
10 20 20 40 40 80
Price of 30-Day SUPPlY
Percentage of Tota I Cholesterol Lowering
Cost per Percentage of Total Cholesterol Lowering
Percentage of LDL Cholesterol Lowering
Cost per Percentage of LDL Cholesterol Lowering
49.18
-13
57.59
-20
3.78 2.87 3.24 4.51 5.46 7.40
-19 -28 -25 -33 -27 -39
2.59 2.05 2.08 3.14 3.84 5.31
-16
51.91
-23 -19 -28
103.65 103.82 207.31
LDL = low-density lipoprotein.
Lovastatin
Versus
Pravastatin
in Reducing
Total and LDL Cholesterol
Lipid/ Lipoprotein
Lovastatin
Total cholesterol LDL cholesterol
-20 -28
(10) (15)
Pravastatin -16 -24
(12) (17)
I
Mean % Change (40 mg/day)
Mean % Change (20 mg/day)
Pravastatln
p Value
(11)
-18 (13)
(15)
-26
p Value
Lovastatin
-23 -32
0.002
(17)
LDL = low-density lipoprotem
than is lovastatin, since lovastatin should be taken with food. Additionally, the Expanded Clinical Evaluation of Lovastatin (EXCEL) study has shown that the efficacy of 40 mg of lovastatin can be increased by 13% by dividing the dosage, rather than giving it once a day.2 There is no difference in the efficacy of pravastatin when the same total dosage is given twice or once daily. In contrast to the conclusions of the Lovastatin Pravastatin Study Group, we found that patients at our institution could be successfully dose-reduced by about 50% when switched from lovastatin to pravastatin. Our real world results are supported by 21 double-blind, doubleplacebo, randomized comparison that demonstrated that the differences in mean reductions of total and LDL cholesterol at 8 weeks were not statistically significant between 20 mg of lovastatin given once daily with the evening meal and 10 mg of pravastatin given at bedtime.’ Our results are significant considering the ever increasing need for cost-effective ways to maintain optimal patient care. Lisa 6. Korman.
PII-D
Newington, Cotkcticut 25 May 1993 1. The Lovastatm Pravastatin Study Group. A multicenter comparative trial of lovastarin and pravastatin
in the treatmentof hypercholesterolemia. 4nr .I Cardid 1993:71:81~~81S. 2. Bradford RH, Shear CL, Chremos AN. Dujovne C, Downton M, Franklin FA, Gould AL, Hesney M, Higgms T, Hurley DP, Langendorfer A, Nash DT, Pool JL, Schnaper H. Expanded Clinical Evaluation of Lovastatin (EXCEL) study resulrs. Amh Intrr-n Med 1991:151:4.~9. 3. McPherson R, Bedard J. Connelly P, Cumew G. Davignon J, Echenberg D, Lavin P, Later L, Lenis J, McQueen M, Montigny M, Munoz C, O’Leary T, Ooi T, Rouleau I, Space D, Tan M, Theroux P. Comparison of the shon-term efficacy and tolerability of lovastatin and pravastatin in the management of priC/in Ther- 1992; 14: mary hypercholesterolemia. 276-29 I.
Lovastatin in Pravastatin Comparative Trial: Cost-Effectiveness In the April 1993 issue of the AJC, the Lovastatin Pravastatin Study Group’ compared the effectiveness of lovastatin and pravastatin in a double-blinded trial. Their final discussion suggests that lovastatin is more effective than is pravastatin across dosing ranges. Unfortunately, I believe that a cost analysis of cholesterol-lowering shows that pravastatin is more effective at the higher dose ranges. The attached table shows a cost breakdown for each percent of cholesterol and lowdensity lipoprotein (LDL) lowering.2 As arranged in the table, one can see the differences in cost per the percentage of total and LDL cholesterol over a 30-day period. This would
suggest that the potency difference is of minimal importance when costeffectiveness is determined. At the lowest dose range, lovastatin would seem to have a cost advantage; however, at higher dose ranges, pravastatin seems to have the more favorable cost. Other analyses of the effects of pravastatin on LDL cholesterol have shown more dramatic results: 22.4, 32.4, and 34.1% at the IO,20 and 40 mg/day doses, respectively.3 If these factors were used in the cost analysis, the cost-effectiveness of pravastatin would be more dramatic. Sam Farbstein,
MD
Chicago Ridge, Illinois 2 July 1993 1. The Lovastatin Pravastarin Study Group. A multicenter comparative trial on lovastatin and pravastatin in the treatment of hypercholesverolemia. Am .I Cardial 1993:71:810-815. 2. MEDLSPAN’s
PrescriptionPricingGuide@,Nation-
al Average Wholesale Prices (AWP), Medispan Inc., March 1993. 3. Jones PH, Farmer JA, Crasman MD, McKenney JM. Wright JT, Proctor JD, Berkson DM, Famham DJ, Wolfson PM, Golfer HT, Rockley CE, Sigmund WR, Schlant RC, Are&erg D, McGovern ME. Oncedaily pravaatatin in patients with primary hyperchole\terolemia: a dose response study. Cli~l C~I&I/ 1991;14:14~151.
Reply: All 3 letters above address issues raised by our study, conceming the comparative lipid-altering efficacy and cost of lovastatin and
READERS’ COMMENTS
417