Wednesday, April 21, 2010

Re-Running An Older Post -- Relevant To Vytorin®, Tonight

Here's a great comment, posted on November 18, 2009 -- about a United Health study presentation that day at a conference in Orlando, Florida; it merits "renewed front-page" exposure [Graphic, at right, depicts the branded version of the drug -- generic versions now abound, though]:

. . . .Let's do a little "Number-Needed-to-Treat" (NNT) and economic analysis, shall we?

From the Stockl presentation of these data at AHA, today:

Vytorin (simvastatin/ezetimibe) 96 events/9983 patients over 1.06 years of follow-up = 0.91%/year event rate

Atorvastatin 115 events/9983 patients over 1.16 years of follow-up = 0.99%/year event rate

Simva 124 events/9983 patients over 1.08 years of follow-up = 1.15%/year event rate

NNT = 1/absolute risk difference

Vytorin (simvastatin/ezetimibe) vs atorvastatin NNT = 1,250. This means you'd have to treat 1250 patients to prevent one event with Vytorin compared to atorvastatin.

Vytorin vs. simvastatin NNT =417

Assuming simvastatin costs 84 cents/day, atorvastatin $3.91/day, and Vytorin $3.74/day:

You'd have to spend $1.7 million to treat 1,250 patients for one year with Vytorin vs. atorvastatin to prevent one event, or spend $570 million for Vytorin vs. simvastatin, for one to prevent one event.

Since your average stroke/MI hospitalization costs about $30,000, we would have to spend way too much money to use Vytorin vs. either atorvastatin or dirt-cheap generic simvastatin. I'm no Peter Orszag, but I'm pretty sure there's no way that will ever be viewed as cost-effective.

Don't think we'll be seeing any such analysis out of the Merck health outcomes shop any time soon.

-- Anonymous, November 18, 2009 10:00 PM. . . .


Anonymous said...

More interesting stuff from the ARBITER-6 paper just published in JACC. Figure 1 tells a huge story! Shows that the greater the exposure (measured by the product of dose/day, adherence, and time on therapy) to ezetimibe, the more atherosclerosis progresses - and the the greater the exposure to niacin, the more athero regresses. This is very damning for ezetimibe, as it takes any sidebar question of relationship to lipids, etc out of the equation, and just simply describes what happens the more drug exposure over time you have.

Does anyone else find it odd that Merck is so silent on this new publication? Quite the contrast from the Merck PR spin blitzkrieg back in November. C'mon Dick, where's that NYT letter-to-the editor about this new paper??? Peter Kim??? Dick Clark??? All you other shills on the Merck gravy train??? This is a material development in the Zetia/Vytorin story, and could even be construed as something positive for your maybe one day niacin product of your very own. Your silence speaks volumes. Guess you're all content to let IMPROVE-IT run until 2013-14, even though everyone with half a brain knows that the number of on-trial events that have already occurred provide you with enough power to detect a clinically meaningful difference between Zetia and placebo right now - all the while collecting as many billions as possible in sales revenue until the trial is done. It really is a great business strategy - too bad it's bereft of any interest in the health of the millions of people takign a drug with no proven clinical value, and with suggestion of clinical harm.

Anonymous said...

So, do you think Dick knew this was coming?
Maybe it explains why Merck isn't going to report any longer on 'sustainability.'

Boy-did Fast Freddie and his Crooks pull one on Merck. But, then again...buyer beware.

I wonder what this might do to the layoff numbers. Sure can't help.

Anonymous said...

I don't think anyone knew this was coming exactly, but if you read the ARBITER-6 authors comments in the NEJM correspondence letters, one could have surmised. Of course, this would have required that someone to actually be interested in science to have read it, as opposed to someone interested mainly in marketing and spin! (Quo vadis, Dick?)

Condor said...

Great commentary, one and all!

I've moved yours to the top o' the page, so the rest of the world is sure to see it.

Thanks for participating!


Nickname unavailable said...

This analysis is incorrect. If Vytorin is cheaper than atorva and has a better event rate, then atorva looks like the dog here.

Condor said...

Dear Nick -- Vytorin is decidedly not cheaper than atorvastatin (branded as Lipitor). Per Northwest Pharmacy Online site quotes:

Vytorin: $109.99 for 30 pills -- 10/10mg.

Lipitor: $29.99 for 30 pills -- 10mg.

The generic form of atorvastatin is much cheaper than the above, but to be fair -- I compared branded to branded. [There is no available generic version of the Vytorin combo pill yet.]

Just FYI.