Cost-Utility Analysis of High-Intensity Statins; Atorvastatin 40 and 80 mg versus Rosuvastatin 20 mg from Egyptian Public Payer’s Perspective: A Markov Model

Abstract Background: Dyslipidemia is a significant burden correlated with the risk of developing cardiovascular morbidity and mortality. However, no available studies compare the cost-utility analysis of high-intensity statins for managing Egyptian patients with dyslipidemia. The study aimed to measure the cost-utility of different high-intensity statins in managing patients with dyslipidemia within the Egyptian public sector. Methods: A half-cycle corrected Markov model with six mutually exclusive health states was developed to reflect the real practice of managing patients with dyslipidemia upon the physician’s decision to use atorvastatin 40 and 80 mg vs. rosuvastatin 20 mg. A 1-year cycle length was applied, and a 10-year time horizon was selected to reflect the long-term consequences. Results: Over the 10 years horizon, atorvastatin 40 mg was associated with the lowest annual cost per percent LDL-C reduction, followed by rosuvastatin 20 mg and atorvastatin 80 mg. Atorvastatin 40 mg generated a total of 4.152 quality-adjusted life years (QALYs), with incremental 0.0012 QALYs, versus rosuvastatin 20 mg, with savings of 3,245 egyptian pounds (EGP). Atorvastatin 80 mg produced a total of 4,159 QALYs, with an incremental 0.0084 QALYs, versus rosuvastatin 20 mg at an incremental cost of 435 EGPs, representing a more cost-effective option under the willingness-to-pay (WTP) threshold in Egypt of 139,000 EGPs. Conclusions: Atorvastatin 40 mg was shown to be strongly dominant over rosuvastatin 20 mg, with numerically higher QALY outcomes and lower associated costs. Atorvastatin 80 mg is considered a cost-effective option versus rosuvastatin 20 mg, with an incremental cost-utility ratio (ICUR) value significantly below the WTP threshold.