Cost-effectiveness of 3 statin sample policies in post-myocardial infarction patients

Objectives: To compare several drug-sampling policies with respect to their potential cost-effectiveness. Study Design: A cost-effectiveness analysis, Markov model, from both health system and payer cost perspectives. Methods: A Markov model with a 10-year time horizon was used to evaluate the cost-effectiveness of the provision of statin samples for statin-naïve, post-myocardial infarction (MI) patients starting at age 65 years from both the health system and payer cost perspectives. Three scenarios were evaluated: no samples, generic samples, and brand samples. Probability inputs were determined using existing data from previous trials and analyses. Secondary sources were used to determine costs and health utilities. Sensitivity analysis was conducted on variables to test robustness and uncertainty in the model. TreeAge Inc software was used, and both utilities and costs were discounted at 3%. Results: Generic sampling was the dominant strategy, having the highest quality-adjusted life-years (QALYs) and lowest costs. The model calculated that a patient who starts taking generic statin samples will have 5.86 discounted QALYs and costs of $47,805, whereas a patient who starts taking brand statin samples will have 5.77 discounted QALYs and costs of $52,868. Sensitivity analysis revealed that the annual probability of a recurrent MI if the patient stops adhering to statins and the probability that the patient will continue adhering to statins while on generic statins affected whether generic sampling was preferred. Conclusion: Use of generic samples should be extended and further evaluated to improve health outcomes and reduce costs.