Table 1.

Main characteristics of the selected studies.

First author, year, setting	Type of study, perspective	Therapeutic target	Alternatives	Model, time horizon (discount)	Cost items	Therapy adherence	Main conclusion	Sponsorship	Therapy resistance
Becerra, 2015, UK20	Cost-utility analysis third-party payer	Secondary cardiovascular disease prevention	Fixed-dose combination polypill (aspirin, atorvastatin and ramipril) vs. multiple monotherapy	Markov, lifetime (3.5% costs and outcomes)	Drugs Cardiovascular disease events and death Hospitalisations Surgical procedures	Yes	The polypill strategy appears to be cost-effective	Yes	No
McConnachie, 2013, UK21	Cost-utility analysis third-party payer	Primary cardiovascular disease prevention	Pravastatin vs. placebo	Cox proportional hazards, 15 years (3.5% costs and outcomes)	Drugs Medical and nurse visits Monitoring and laboratory tests	No	Pravastatin treatment is cost saving and increases QALYs in middle-aged men	Yes	No
Barrios, 2012, Spain22	Cost-utility analysis third-party payer	Primary and secondary cardiovascular disease prevention	Rosuvastatin vs. generic atorvastatin	Markov, 20 years (3% costs and outcomes)	Drugs Hospitalisation and follow-up	No	Rosuvastatin is more cost-effective than generic atorvastatin	Yes	No
Liew, 2012, Belgium23	Cost-utility analysis third-party payer	Primary cardiovascular disease prevention	Remaining on atorvastatin vs. switching to simvastatin	Markov, 20 years (3% costs, 1.5% outcomes)	Drugs Hospitalisation and follow-up	No	Remaining on atorvastatin should be costeffective	Yes	No
Ohsfeldt, 2012, Sweden24	Cost-utility analysis third-party payer	Primary cardiovascular disease prevention	Rosuvastatin vs. placebo	Probabilistic Monte Carlo, lifetime (3% costs and outcomes)	Drugs Medical visits Monitoring tests Hospitalisations	Yes	Rosuvastatin is cost-saving in patients with 10-year risk of cardiovascular disease events	Yes	No
Michailov, 2012, Germany25	Cost-utility analysis third-party payer	Secondary cardiovascular disease prevention	Simvastatin plus niacin/laropiprant vs. simvastatin	Markov, lifetime (3% costs and outcomes)	Drugs Medical visits Laboratory tests cardiovascular disease events and deaths	No	Addition of niacin/laropiprant to simvastatin is cost-effective in patients not at low-density lipoprotein cholesterol goal	Yes	Yes
Ara, 2012, UK26	Cost-utility analysis third-party payer	Patient with acute coronary syndrome	Atorvastatin 80 mg /rosuvastatin 40 mg vs. simvastatin 40 mg	Markov, lifetime (3.5% costs and outcomes)	Drugs Medical visits Laboratory tests Cardiovascular disease events and follow-up	Yes	Rosuvastatin 40 mg is estimated to be more cost-effective	No	No
Greving, 2011, NL27	Cost-utility analysis third-party payer	Primary cardiovascular disease prevention	Low-dose statin vs. no treatment	Markov, 10 years (4% costs, 1.5% outcomes)	Drugs Medical visits Pharmacists’ fees Laboratory tests Cardiovascular disease events, follow-up and death	Yes	Statins seem not to be cost-effective for primary prevention in patients at low risk	No	No
Plans-Rubió, 2010, Spain28	Cost-effectiveness analysis third-party payer	Primary cardiovascular disease prevention	Atorvastatin/fluvastatin/lovastatin/pravastatin/rosuvastatin/ simvastatin vs. no treatment Statin + cholestyramine/ezetimibe vs. no treatment	Metanalysis for efficacy, 1 year	Drugs Medical visits Laboratory tests Adverse effects	No	Rosuvastatin should be cost-effective for patients with high risk, but combination therapies for greater reductions in low-density lipoprotein cholesterol, and simvastatin for those with moderate or low CHD risk	No	Yes
Reckless, 2010, UK29	Cost-utility analysis third-party payer	Patients with acute coronary syndrome	Switching to simvastatin + ezetimibe vs. doubling submaximal statin doses	Markov, lifetime (3.5% costs and outcomes)	Drugs Medical visits Cardiovascular disease events, follow-up and death	No	Switching to simvastatin + ezetimibe is cost-effective	Yes	No
Lorgelly, 2010, UK30	Cost-effectiveness analysis third-party payer	Systolic heart failure	Rosuvastatin vs. placebo	Within trial analysis, 3 years (3.5% costs and outcomes)	Drugs Hospitalisations Surgical procedures	Yes	Rosuvastatin significantly reduces healthcare costs	Yes	No
Nherera, 2010, UK31	Cost-utility analysis third-party payer	Familial hypercholesterolaemia (FH)	High-intensive statins vs. low-intensive statins	Markov, lifetime (3.5% costs and outcomes)	Drugs Cardiovascular disease events and follow-up Surgical procedures	No	High-intensive statins are cost-effective for younger FH patients	No	No
Martikainen, 2010, Sweden32	Cost-effectiveness analysis third-party payer	High-risk patients with hypercholes terolaemia	Eight treatment strategies including high-intensive statins	Probabilistic decision tree, 1 year	Drugs Medical visits Laboratory tests Travelling	No	Rosuvastatin in high low-density lipoprotein cholesterol patients is cost-effective	Yes	Yes
Soini, 2010, Finland33	Cost-utility analysis Society	Secondary prevention of coronary heart disease	Simvastatin 40 mg/ atorvastatin 20 mg/ rosuvastatin 10 mg + ezetimibe 10 mg vs. simvastatin 40mg	Markov, lifetime (3% costs and outcomes)	Drugs Medical visits Monitoring and laboratory tests Hospitalisations Travelling	No	Switching to simvastatin + ezetimibe is cost-effective in patients not at goal	Yes	Yes
Taylor, 2009, UK, Spain, Germany34	Cost-utility analysis third-party payer	Secondary cardiovascular disease prevention	Atorvastatin 80 mg vs. atorvastatin 10 mg	Markov, lifetime (3.5% costs and outcomes)	Drugs Cardiovascular disease events Surgical procedures	No	Atorvastatin 80 mg is cost-effective	Yes	No
Peura, 2008, Finland35	Cost-utility analysis third-party payer	Primary and secondary coronary heart disease prevention	Rosuvastatin/ vs. simvastatin	Markov, lifetime (5% costs and outcomes)	Drugs Medical visitsLaboratory tests Myocardial infarction events and death Travelling	No	Rosuvastatin can be considered potentially cost-effective	Yes	No
Gouveia Pinto, 2008, Portugal36	Cost-effectiveness analysis third-party payer	Hypercholesterolemia and prevention of ischemic heart disease	Rosuvastatin vs. atorvastatin/pravastatin/simvastatin	Markov, lifetime (5% costs and outcomes)	Drugs Medical visits Laboratory tests Myocardial infarction events Examinations	Np	Rosuvastatin is a cost-effective alternative	Yes	No
Lindgren, 2007, Scandinavian countries37	Cost-effectiveness analysis, Cost-utility analysis Society	Secondary cardiovascular disease prevention	High-dose atorvastatin vs. regular dose simvastatin	Markov, lifetime (3% costs and outcomes)	Drugs Hospitalisations Surgical procedures Productivity loss	Np	High-dose atorvastatin appears to be cost-effective	Yes	No
Scuffham, 2006, Hungary38	Cost-effectiveness analysis, Cost-utility analysis third-party payer	Treatment after percutaneous coronary intervention	Fluvastatin vs. no treatment	Markov, 10 years (5% costs and outcomes)	Drugs Medical visits Cardiovascular disease deaths Hospitalisations	Yes	Fluvastatin is cost-effective	Yes	No