Lisa A. Prosser, PhD; Aaron A. Stinnett, PhD; Lee Goldman, MD, MPH; Milton C. Weinstein, PhD
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Prosser LA, Stinnett AA, Goldman L, Weinstein MC. Cost-Effectiveness Analyses. Ann Intern Med. 2001;135:382-383. doi: 10.7326/0003-4819-135-5-200109040-00022
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Published: Ann Intern Med. 2001;135(5):382-383.
We agree with Dr. Clark that it is often relevant to differentiate between the decision to tailor therapy once treatment has been initiated and the decision to initiate treatment that we evaluated. In our cost-effectiveness analysis, we modeled dosages and lipid levels achieved by using data from observed practices in randomized clinical trials of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), rather than on treatment guidelines for actual practice. For primary prevention, we used data from several large-scale trials that used a dosage of 40 mg of pravastatin per day (1-3). For secondary prevention, our analysis modeled a strategy based on the intervention evaluated in the Scandinavian Simvastatin Survival Study, in which patients initially received 20 mg of simvastatin daily and doses were titrated up or down on the basis of levels of low-density lipoprotein cholesterol. The average daily dose was 27 mg, which includes patients whose daily dose decreased to 10 mg or increased to 40 mg (4).
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