Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP) Borislava.

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Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP) Borislava Mihaylova, DPhil, Iryna Schlackow, DPhil, William Herrington, MD, Jingky Lozano-Kühne, PhD, Seamus Kent, MSc, Jonathan Emberson, PhD, Christina Reith, FRCP, Richard Haynes, DM, FRCP, Alan Cass, PhD, Jonathan Craig, PhD, Alastair Gray, PhD, Rory Collins, FRS, Martin J. Landray, PhD, FRCP, Colin Baigent, FRCP R. Collins, C. Baigent, M.J. Landray, C. Bray, Y. Chen, A. Baxter, A. Young, M. Hill, C. Knott, A. Cass, B. Feldt-Rasmussen, B. Fellström, D.E. Grobbee, C. Grönhagen-Riska, M. Haas, H. Holdaas, L.S. Hooi, L. Jiang, B. Kasiske, U. Krairittichai, A. Levin, Z.A. Massy, V. Tesar, R. Walker, C. Wanner, D.C. Wheeler, A. Wiecek, T. Dasgupta, W. Herrington, D. Lewis, M. Mafham, W. Majoni, C. Reith, J. Emberson, S. Parish, D. Simpson, J. Strony, T. Musliner, L. Agodoa, J. Armitage, Z. Chen, J. Craig, D. de Zeeuw, J.M. Gaziano, R. Grimm, V. Krane, B. Neal, V. Ophascharoensuk, T. Pedersen, P. Sleight, J. Tobert, C. Tomson Borislava Mihaylova, DPhil, Iryna Schlackow, DPhil, William Herrington, MD, Jingky Lozano-Kühne, PhD, Seamus Kent, MSc, Jonathan Emberson, PhD, Christina Reith, FRCP, Richard Haynes, DM, FRCP, Alan Cass, PhD, Jonathan Craig, PhD, Alastair Gray, PhD, Rory Collins, FRS, Martin J. Landray, PhD, FRCP, Colin Baigent, FRCP R. Collins, C. Baigent, M.J. Landray, C. Bray, Y. Chen, A. Baxter, A. Young, M. Hill, C. Knott, A. Cass, B. Feldt-Rasmussen, B. Fellström, D.E. Grobbee, C. Grönhagen-Riska, M. Haas, H. Holdaas, L.S. Hooi, L. Jiang, B. Kasiske, U. Krairittichai, A. Levin, Z.A. Massy, V. Tesar, R. Walker, C. Wanner, D.C. Wheeler, A. Wiecek, T. Dasgupta, W. Herrington, D. Lewis, M. Mafham, W. Majoni, C. Reith, J. Emberson, S. Parish, D. Simpson, J. Strony, T. Musliner, L. Agodoa, J. Armitage, Z. Chen, J. Craig, D. de Zeeuw, J.M. Gaziano, R. Grimm, V. Krane, B. Neal, V. Ophascharoensuk, T. Pedersen, P. Sleight, J. Tobert, C. Tomson American Journal of Kidney Diseases Volume 67, Issue 4, Pages 576-584 (April 2016) DOI: 10.1053/j.ajkd.2015.09.020 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Effect of allocation to simvastatin plus ezetimibe treatment on all major atherosclerotic events in SHARP (Study of Heart and Renal Protection). 183% of participants in this category with chronic kidney disease (CKD) stage 3b (estimated glomerular filtration rate of 30-<45mL/min/1.73m2). Abbreviations: CI, confidence interval; CVD, cardiovascular disease; LDL-C, low-density lipoprotein cholesterol. American Journal of Kidney Diseases 2016 67, 576-584DOI: (10.1053/j.ajkd.2015.09.020) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Effect of allocation to simvastatin plus ezetimibe treatment on costs of vascular hospital episodes in SHARP (Study of Heart and Renal Protection). 183% of participants in this category with chronic kidney disease (CKD) stage 3b (estimated glomerular filtration rate of 30-<45mL/min/1.73m2). Abbreviations: CI, confidence interval; CVD, cardiovascular disease; LDL-C, low-density lipoprotein cholesterol; SE, standard error. American Journal of Kidney Diseases 2016 67, 576-584DOI: (10.1053/j.ajkd.2015.09.020) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Net cost per major atherosclerotic event avoided in SHARP (Study of Heart and Renal Protection) with simvastatin, 20mg, plus ezetimibe, 10mg, daily at different prices in patients (A) at different cardiovascular disease risk and (B) at different stages of chronic kidney disease (CKD). Negative figures indicate cost savings. 183% of participants in this category with CKD stage 3b (estimated glomerular filtration rate of 30-<45mL/min/1.73m2). American Journal of Kidney Diseases 2016 67, 576-584DOI: (10.1053/j.ajkd.2015.09.020) Copyright © 2016 The Authors Terms and Conditions