A study of efficacy and cost-effectiveness of selected statins in Hospital Sultan Abdul Halim

Introduction: This retrospective study was conducted in out-patient pharmacy of Hospital Sultan Abdul Halim (HSAH) Sungai Petani, Kedah to observe the efficacy and cost- effectiveness of selected statins which lowered the level of total cholesterol, triglyceride, low density lipoprotein cholesterol and elevated high density lipoprotein cholesterol in the treatment of hypercholesterolemia.

Objective: To compare the efficacy and cost-effectiveness of selected statins, determine relationship between statins prices and mean percentage reduction of cholesterol level, determine which statins is the most effective and cost-effective in reducing cholesterol level.

Methodology: A retrospective study was conducted utilizing electronic base of outpatients who were treated as outpatients in the hospital. The outpatients data were extracted from the electronic database of e-Hospital Information System (e-HIS) using their registered number. Microsoft Excel version 2013 was used for data management, analysis, calculation, asses mean and standard deviation for each statin type.

Result: The mean percentage reduction of total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol after 9 months on Atorvastatin, Simvastatin and Rosuvastatin are [-4.55%, -6.41%, 2.97%, -6.83%], [-7.27%, -2.78%, 1.93%, -0.03%] and [-24.46%, -36.57%, 71.26%, -29.77%] respectively. The cost-effectiveness per tablet of Atorvastatin, Simvastatin and Rosuvastatin in 9 months on total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol are [0.08%, 0.12%, 0.06%, 0.13%], [0.36%, 0.14%, 0.10%, 0.001%] and [0.09%, 0.135%, 0.263%, 0.11%] respectively. The cost-effectiveness per RM1 Atorvastatin, Simvastatin and Rosuvastatin in 9 months on total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol are [0.40%, 0.60%, 0.30%, 0.65%], [4.68%, 1.82%, 1.3%, 0.01%] and [0.09%, 0.14%, 0.26%, 0.11%] respectively.

Discussion: When Atorvastatin, Simvastatin and Rosuvastatin compared with the original brand, Lipitor®, Zocor® and Crestor®, the differences of mean percentage reduction of low density lipoprotein cholesterol are [6.83% and 49.6% ] [0.03% and 26%-47%] [29.77% and 45%-63%]. The clinical results are not approximate to the clinical trials of original brand are due to some factors which are daily lifestyle, dietary habit, pharmacogenetic, errors and compliance.

Conclusion: Overall, the most effective statin between the selected statins are Rosuvastatin 10mg while the most cost-effective statin is Simvastatin 40mg.