***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The CARDS trial , a multicentre , r and omized , controlled trial , found that atorvastatin 10 mg/day for patients with type 2 diabetes mellitus and normal low-density lipoprotein (LDL)-cholesterol significantly reduced cardiovascular ( CV ) events , including stroke . We estimated the cost effectiveness of atorvastatin as primary prevention against CV disease from the short-term and lifetime US payer perspectives . Research design and methods We constructed a decision analytic ( Markov ) model to evaluate long-term costs and outcomes for atorvastatin 10 mg/day versus no HMG-CoA reductase inhibitor ( statin ) therapy for patients with type 2 diabetes and no history of a CV event .  CV event rates and survival were based on risk equations calibrated to CARDS and applied to a US type 2 diabetes population ; the atorvastatin effect on CV events was based on hazard ratios from CARDS ; direct medical care costs were based on US treatment patterns and published costs analyses of patients with diabetes . Costs were valued in $ US , year 2005 values ; costs and benefits were discounted at 3 % per annum . Results Within the time horizon of the trial ( 5 years ) , the cost effectiveness of atorvastatin was $ US137 276 per QALY . At 10 years , the incremental cost per QALY improved to $ US3640 per QALY . At 25 years , overall costs were lower and QALYs higher in the atorvastatin arm . Costs of managing CV events were lower after 5 years for patients treated with atorvastatin . Conclusions For patients with type 2 diabetes and one additional risk factor for CV disease , normal LDL-cholesterol and no history of a CV event , primary prevention with atorvastatin appears to be cost saving and improve outcomes over 25 years , although it is costly from a short-term US payer perspective . From both a medical and an economic viewpoint , primary prevention is desirable in this patient population BACKGROUND The objective of this study was to assess the cost-effectiveness of pravastatin therapy in survivors of myocardial infa rct ion with average cholesterol levels . METHODS We performed a cost-effectiveness analysis based on actual clinical , cost , and health-related quality -of-life data from the Cholesterol and Recurrent Events ( CARE ) trial . Survival and recurrent coronary heart disease events were modeled from trial data in Markov models , with the use of different assumptions regarding the long-term benefit of therapy . RESULTS Pravastatin therapy increased quality -adjusted life expectancy at an incremental cost of $ 16,000 to $ 32,000 per quality -adjusted life-year gained . In subgroup analyses , the cost-effectiveness of pravastatin therapy was more favorable for patients > 60 years of age and for patients with pretreatment low-density lipoprotein cholesterol levels > 125 mg/dL. Results were sensitive to the cost of pravastatin and to assumptions about long-term survival benefits from pravastatin therapy . CONCLUSIONS The cost-effectiveness of pravastatin therapy in survivors of myocardial infa rct ion with average cholesterol levels compares favorably with other interventions Background Simvastatin , 20 mg , plus ezetimibe , 10 mg , daily ( simvastatin plus ezetimibe ) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease ( CKD ) in the Study of Heart and Renal Protection ( SHARP ) , but its cost-effectiveness is unknown . Study Design Cost-effectiveness of simvastatin plus ezetimibe in SHARP , a r and omized controlled trial . Setting & Population 9,270 patients with CKD r and omly assigned to simvastatin plus ezetimibe versus placebo ; participants in categories by 5-year cardiovascular risk ( low , < 10 % ; medium , 10%-<20 % ; or high , ≥20 % ) and CKD stage ( 3 , 4 , 5 not on dialysis , or on dialysis therapy ) . Model , Perspective , & Timeline Assessment during SHARP follow-up from the UK perspective ; long-term projections . Intervention Simvastatin plus ezetimibe ( 2015 UK £ 1.19 per day ) during 4.9 years ’ median follow-up in SHARP ; scenario analyses with high-intensity statin regimens ( 2015 UK £ 0.05-£1.06 per day ) . Outcomes Additional health care costs per major atherosclerotic event avoided and per quality -adjusted life-year ( QALY ) gained . Results In SHARP , the proportional reductions per 1 mmol/L of low-density lipoprotein ( LDL ) cholesterol reduction  with simvastatin plus ezetimibe in all major atherosclerotic events of 20 % ( 95 % CI , 6%-32 % ) and in the costs of vascular hospital episodes of 17 % ( 95 % CI , 4%-28 % ) were similar across participant categories by cardiovascular risk and CKD stage . The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy . The net cost per major atherosclerotic event  avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £ 157,060 in patients at low risk to £ 15,230 in those at high risk ( £ 30,500-£39,600 per QALY ) ; and from £ 47,280 in CKD stage 3 to £ 28,180 in patients on dialysis therapy ( £ 13,000-£43,300 per QALY ) . In scenario analyses , generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost . Limitations High-intensity statin-alone regimens were not studied in SHARP . Conclusions Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP , but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD OBJECTIVE To evaluate the incremental cost-effectiveness ratio ( ICER ) of switching to ezetimibe/simvastatin ( Eze/Simva ) compared with doubling the submaximal statin doses , in patients with acute coronary syndrome ( ACS ) events in the INFORCE study . METHODS Lifetime treatment costs and benefits were computed using a Markov model . Model inputs included each patient 's cardiovascular risk factor profile and actual lipid values at baseline and 12 weeks ( endpoint ) . Cardiovascular event and drug costs were discounted at 3.5 % . Age-specific utilities were based on UK literature values and non-coronary heart disease mortality rates on the Office of National Statistics data . In the INFORCE study , 384 patients taking statins at stable doses for ≥6 weeks before hospital admission were stratified by statin dose/potency ( low , medium , and high ) and then r and omized to doubling the statin dose or switching to Eze/Simva 10/40 mg for 12 weeks . RESULTS The Eze/Simva  group ( n=195 ) had a higher mean baseline total cholesterol than the double-statin group ( n=189 ) . Analyses were adjusted for baseline characteristics . In the INFORCE study , Eze/Simva  reduced low-density lipoprotein cholesterol ( LDL-C ) by ∼30 % ( vs. 4 % with doubling statin doses ) and significantly enhanced LDL-C goal attainment . In the cost-effectiveness analysis , Eze/Simva conferred 0.218 incremental discounted quality -adjusted life year ( QALY ) at a discounted incremental cost of £ 2524 , for an ICER of £ 11,571/QALY ( 95 % confidence interval=£8181-£18,600/QALY ) . The ICER was £ 13,552/QALY , £ 11,930/QALY , and £ 10,148/QALY in the low- , medium- , and high-potency strata , respectively . CONCLUSIONS Switching to Eze/Simva 10/40 mg is projected to be a cost-effective treatment ( vs. double-statin ) in UK patients with ACS OBJECTIVES Mathematical modeling is used widely in economic evaluations of pharmaceuticals and other health-care technologies . Users of models in government and the private sector need to be able to evaluate the quality of models according to scientific criteria of good practice . This report describes the consensus of a task force convened to provide modelers with guidelines for conducting and reporting modeling studies . METHODS The task force was appointed with the advice and consent of the Board of Directors of ISPOR . Members were experienced developers or users of models , worked in academia and industry , and came from several countries in North America and Europe . The task force met on three occasions , conducted frequent correspondence and exchanges of drafts by electronic mail , and solicited comments on three drafts from a core group of external review ers and more broadly from the membership of ISPOR . RESULTS Criteria for assessing the quality of models fell into three areas : model structure , data used as inputs to models , and model validation . Several major themes cut across these areas . Models and their results should be represented as aids to decision making , not as statements of scientific fact ; therefore , it is inappropriate to dem and that models be vali date d prospect ively before use . However , model assumptions regarding causal structure and parameter estimates should be continually assessed against data , and models should be revised accordingly . Structural assumptions and parameter estimates should be reported clearly and explicitly , and opportunities for users to appreciate the conditional relationship between inputs and outputs should be provided through sensitivity analyses . CONCLUSIONS Model-based evaluations are a valuable re source for health-care decision makers . It is the responsibility of model developers to conduct modeling studies according to the best practicable st and ards of quality and to communicate results with adequate disclosure of assumptions and with the caveat that conclusions are conditional upon the assumptions and data on which the model is built OBJECTIVE To measure the cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with established ischaemic heart disease and average baseline cholesterol levels . DESIGN Prospect i ve economic evaluation within a double-blind r and omised trial ( Long-Term Intervention with Pravastatin in Ischaemic Disease [ LIPID ] ) , in which patients with a history of unstable angina or previous myocardial infa rct ion were r and omised to receive 40 mg of pravastatin daily or matching placebo . PATIENTS AND SETTING 9014 patients aged 35 - 75 years from 85 centres in Australia and New Zeal and , recruited from June 1990 to December 1992 . MAIN OUTCOME MEASURES Cost per death averted , cost per life-year gained , and cost per quality -adjusted life-year gained , calculated from measures of hospitalisations , medication use , outpatient visits , and quality of life . RESULTS The LIPID trial showed a 22 % relative reduction in all-cause mortality ( P < 0.001 ) . Over a mean follow-up of 6 years , hospital admissions for coronary heart disease and coronary revascularisation were reduced by about 20 % . Over this period , pravastatin cost $ A4913 per patient , but reduced total hospitalisation costs by $ A1385 per patient and other long-term medication costs by $ A360 per patient . In a sub sample of patients , average quality of life was 0.98 ( where 0 = dead and 1 = normal good health ) ; the treatment groups were not significantly different . The absolute reduction in all-cause mortality was 3.0 % ( 95 % CI , 1.6%-4.4 % ) , and the incremental cost was $ 3246 per patient , result ing in a cost per life saved of $ 107 730 ( 95 % CI , $ 68 626-$209 881 ) within the study period . Extrapolating long-term survival from the placebo group , the undiscounted cost per life-year saved was $ 7695 ( and $ 10 938 with costs and life-years discounted at an annual rate of 5 % ) . CONCLUSIONS Pravastatin  therapy for patients with a history of myocardial infa rct ion or unstable angina and average cholesterol levels reduces all-cause mortality and appears cost effective compared with accepted treatments in high-income countries Aims To assess the impact on healthcare re source utilization , costs , and quality of life over 15 years from 5 years of statin use in men without a history of myocardial infa rct ion in the West of Scotl and Coronary Prevention Study ( WOSCOPS ) . Methods Six thous and five hundred and ninety-five participants aged 45–54 years were r and omized to 5 years treatment with pravastatin ( 40 mg ) or placebo . Linkage to routinely collected health records extended follow-up for secondary healthcare re source utilization to 15 years . The following new results are reported : cause-specific first and recurrent cardiovascular hospital admissions including myocardial infa rct ion , heart failure , stroke , coronary revascularization and angiography ; non-cardiovascular hospitalization ; days in hospital ; quality -adjusted life years ( QALYs ) ; costs of pravastatin treatment , treatment safety monitoring , and hospital admissions . Results 
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LIMITATIONS AND CONCLUSIONS The finding that few CEA models included mortality inputs from individual RCTs of lipid-lowering therapy may be surprising , as one might expect that treatment efficacy should be based on robust clinical evidence .