Cost-Effectiveness of Crystalline and Amorphous Atorvastatin in the Secondary Prevention of Cardiovascular Disease

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Supabhorn Onsanit
Kesinee Wanichang
Kraisorn Anutarapongpan


Background and Objective: Atorvastatin has one of the highest rate of prescribed medications at Queen Sirikit Heart Center of the Northeast, Khon Kaen University. When generic drugs that were equivalent to the original drugs pharmaceutically produced, the generic was included in the list of Hospital medicines at Queen Sirikit Heart Center. However, the original atorvastatin was still available. The original drug was in crystalline form whereas the generic form was in amorphous form. The main objective of this study was to estimate the cost-effectiveness of crystalline and amorphous atorvastatin for the secondary prevention of cardiovascular disease at Queen Sirikit Heart Center of the Northeast, Khon Kaen University.

Methods: This was a retrospective study. We reviewed the database and medical record of patients whose treatment regimen had been switched from crystalline atorvastatin to amorphous atorvastatin and who had undergone treatment with each polymorph for at least six weeks. Effectiveness was determined based on the proportion of patients in whom the treatment goals were achieved according to ESC/EAS 2016 guidelines (LDL-C goal < 70 mg/dL). The cost-effectiveness ratio target achievement rate (CER-TA) was determined for analysis of cost-effectiveness.

Results: Of the 2,185 patients who had received amorphous atorvastatin, 951 had been changed from crystalline atorvastatin to amorphous atorvastatin for secondary cardiovascular prevention. The mean LDL-C of amorphous atorvastatin was less than that of patients using crystalline atorvastatin (mean ± SD: 92.24 ± 40.2, 96.92 ± 40.8 respectively), a result which was statistically significant (p <0.001). The proportion of patients in whom treatment goals were achieved through treatment with amorphous atorvastatin was 26.3 % and crystalline atorvastatin was 21.4%, which was also a statistically significant finding (p =0.001). Results of cost-effectiveness analysis found that CER-TA of amorphous atorvastatin was lower than that of crystalline atorvastatin (136.4 and 440.4 baht per proportion of patients who achieved treatment goals).

Conclusion: The CER-TA of amorphous atorvastatin in the secondary prevention of cardiovascular disease was lower than that of crystalline atorvastatin.



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