Key result
Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but relatively more expensive in developing countries.
Why the study?
Following findings that rosuvastatin alone or with candesartan and HCT reduced cardiovascular events in intermediate-risk individuals, the cost implications of implementation across countries at different economic levels remained to be assessed.
Is the use of rosuvastatin alone or with candesartan/HCT cost-effective for primary prevention in individuals at intermediate risk across different economic regions?
RCT (n=12,705)
Yes
Is the use of rosuvastatin alone or with candesartan/HCT cost-effective for primary prevention in individuals at intermediate risk across different economic regions?
Primary prevention with rosuvastatin and candesartan/HCT is cost-saving in developed countries but remains relatively expensive in developing countries, highlighting the need for price reductions to ensure affordability.
May inform regional prescribing decisions; leaves open affordability gaps in developing countries pending price reductions.
AIMS: The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels. METHODS AND RESULTS: Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries. CONCLUSION: Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use. CLINICAL TRIAL REGISTRATION: HOPE-3 ClinicalTrials.gov number, NCT00468923.
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Lamy et al. (2019) conducted an RCT in Intermediate risk and without cardiovascular disease (n=12,705). Rosuvastatin alone or with candesartan and hydrochlorothiazide vs. Placebo was evaluated on Average cost per patient in US dollars for the duration of the study. Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but relatively more expensive in developing countries.
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