Analytical approach:
A Markov model was used to synthesise the data from published studies. The authors specified a 20-year period for the analysis and stated that the perspective of the Brazilian public health system was used.
Effectiveness data:
The clinical estimates included LDL-cholesterol reduction and the incidence of cardiovascular events. The evidence for the clinical estimates was abstracted from a meta-analysis of 58 randomised controlled trial (RCT)s (Law, et al. 2003, see ‘Other Publications of Related Interest’ below for bibliographic details) and one RCT (Heart Protection Study Collaborative Group. 2002, see ‘Other Publications of Related Interest’ below for bibliographic details). The methods used to select these studies were not reported.
Monetary benefit and utility valuations:
Not relevant.
Measure of benefit:
The two measures of benefit were life-years gained (LYG) and cardiovascular events avoided; both were discounted at 7% per year.
Cost data:
The types of resources were the costs of the drugs, acute myocardial infarction, cerebrovascular accidents, and post-event and preventive routine follow-ups. The unit costs were not presented except for the statins. The data on resources used and their valuations were derived from Brazilian Department of Health price guides, manufacturer price listings, and clinical guidelines. The prices were in 2007 Brazilian reais (BRL) and were adjusted to exclude 8% Merchandise Circulation Tax (ICMS) and discounted at 7% per year.
Analysis of uncertainty:
The parameter uncertainty was assessed using sensitivity analyses of unknown type and unreported parameter values. Scenario analyses were undertaken for cohorts of different ages (44, 55, and 65 years) and for a lower LDL-cholesterol level of 160mg/dL.