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Purpose: Prudent decisions about the role of new pharmaceutical agents are important for cost-effective, high quality care. To determine the impact of rosuvastatin, approved for use in 2003, on optimal clinical use of the statins, a multi-criteria decision analysis based on the STEP approach -Safety, Tolerability, Effectiveness, Price - to comparing different pharmaceutical agents. (BMJ. 1996;312:1494) was performed using the Analytic Hierarchy Process.
Methods: Data were obtained from the literature regarding the safety, tolerability, and effectiveness of the 6 statins currently available in the US: atorvastatin (A), fluvastatin (F), lovastatin (L), pravastatin (P), rosuvastatin (R), and simvastatin (S). Average wholesale prices (Medical Letter 2004;46:38) were used to compare out-of-pocket costs. All statins are believed to be equally tolerable, so this criterion was removed from the analysis. Effectiveness was divided into LDL-C lowering and proven patient outcomes; LDL lowering was considered much more important. Safety was divided into 3 equally important sub-criteria: proven long term safety, minimal renal dose adjustments, and low potential for drug-drug interactions. The impact of rosuvastatin was determined by comparing the relative rankings of the statins without and with rosuvastatin.
Results: If cost is disregarded, and effectiveness and safety are considered equally important, atorvastatin (22.6% & 18.7%) and pravastatin (22.0% & 18.2%) are the top two drugs regardless of whether rosuvastatin is available or not. Rosuvastatin becomes the drug of choice when the relative priorities of effectiveness and safety are ≥78% and ≤22% respectively. When safety, effectiveness and price are included and considered equally important, atorvastatin (21.9% & 18.1%), fluvastatin (21.7% & 18.1%) and lovastatin (20.9% & 17.4%) are the three highest ranked statins both without and with rosuvastatin. Rosuvastatin becomes the drug of choice only when the priority of effectiveness is ≥65% and the priorities of safety and cost are ≤17.5% each.
Conclusions: For most patients, previously available statins are better choices than rosuvastatin. Its use should, therefore, be restricted to circumstances where effectiveness is the overriding concern. The proper use of statins depends on the relative priorities of safety, effectiveness, and price; routine assessment and integration of these considerations into prescribing decisions would help promote optimal use of these drugs. Routine, multi-criteria clinical assessment of new pharmaceuticals can help promote both quality of care and effective management of pharmaceutical costs.
See more of Poster Session - CEA: Methods and Applications; Health Services Research
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)