Comparative Cost-Effectiveness of Fluvastatin and Lovastatin in Patients with Hypercholesterolemia

OBJECTIVE: Effectiveness of lovastatin and fluvastatin based on lowering LDL cholesterol in patients with primary hypercholesterolemia. DESIGN: Single-center, open-label, randomized crossover eight-week comparison of equal doses (20 mg and 40 mg daily) of lovastatin and fluvastatin. SETTING: University-affiliated outpatient cardiology clinic. PATIENTS: Forty patients (19 men and 21 women) aged 58 :I: 17 years with primary hypercholesterolemia (baseline LDL cholesterol 160mg/dl or higher). MEASUREMENTS: Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were obtained after an eight-week American Heart Association Step 1 diet and after eight weeks of treatment with lovastatin and fluvastatin. Cost analyses included cost per percent change in LDL cholesterol, cost per successfully treated patient, and incremental cost-effectiveness. RESULTS: All 40 patients successfully completed the crossover without the development of dose-limiting side effects. No patient developed abnormal serum transaminases (ALT/AST) or creatinine phosphokinase (CPtless than) values. Lovastatin produced statistically significantly greater reductions in total cholesterol (p=0.002) and LDL cholesterol (p=0.006) than fluvastatin. A statistically greater number of patients achieved National Cholesterol Education Program (NCEP) LDL-cholesterol goals with lovastatin than with fluvastatin. Cost per percent LDL-cholesterol reduction was less for fluvastatin than for lovastatin. Cost per successfully treated patient favored fluvastatin in low- and moderate- risk patients and lovastatin in high risk patients. CONCLUSION: The respective cost effectiveness of fluvastatin and lovastatin depends on the risk distribution of the patient population to be treated and on their baseline LDL �cholesterol levels.