ClinicoEconomics and Outcomes Research (Oct 2018)
A single blind, multicenter, randomized controlled trial to evaluate the effectiveness and cost of a novel nutraceutical (LopiGLIK®) lowering cardiovascular disease risk
Abstract
Andrea Manfrin,1 Valentina Trimarco,2,3 Maria Virginia Manzi,2,4 Francesco Rozza,2,4 Raffaele Izzo2,5 1Sussex Pharmacy, School of Life Sciences, University of Sussex, Falmer, Brighton, UK; 2Hypertension Research Centre, University of Naples Federico II, Naples, Italy; 3Department of Neurosciences, Federico II University, Naples, Italy; 4Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; 5Department of Translational Medical Science Sciences, Federico II University, Naples, Italy Context: Cardiovascular disease (CVD) costs the economy €210 billion per year in Europe. There is an association between low-density lipoprotein cholesterol (LDL-C) and CVD risk.Objective: To evaluate the cost and effectiveness of LopiGLIK® (LOPI) in lowering LDL-C and CVD risk.Design: Single blind multicenter randomized controlled trial; patients were divided into two groups, subjected to centralized randomization.Setting: Four Italian regions.Participants: Thirty-one physicians enrolled 573 adult patients with mild hypercholesterolemia between January 2016 and January 2018.Intervention: Patients were treated for 16 weeks either with LOPI (intervention) or Armolipid Plus® (AP; control).Outcome measures: Primary outcome: percentage of patients who achieved LDL-C <130 mg/dL. Secondary outcomes: reduction of HbA1c, survival analysis and HR linked to 38.67 mg/dL reduction of LDL-C and 1% reduction of HbA1c. Costs were assessed per unit and cure.Results: Three hundred and seventy patients treated with LOPI and 203 treated with AP were randomized and completed the study. At baseline 8.9% (n=18) patients treated with AP and 9.5% (n=35) treated with LOPI had LDL-C levels <130 mg/dL (P=0.815). At the 16-week follow-up, 41.4% (n=84) of patients treated with AP and 67.6% (n=250) with LOPI achieved LDL-C levels <130 mg/dL (P<0.001). LOPI patients were three times more likely to achieve LDL-C levels <130 mg/dL; adjusted OR 2.97 (95% CI; 2.08–4.24; P<0.001), number needed to treat was four (95% CI; 5.60–2.90; P<0.001). Survival analysis demonstrated the superiority of LOPI vs AP relative to 38.67 mg/dL LDL-C reduction (P<0.002); HR was 0.761 (95% CI; 0.62–0.94; P<0.001). Both products reduced the HbA1c without a significant difference between them (P=0.156). Survival analysis and HR (0.91; 95% CI; 0.70–1.18) estimated for 1% HbA1c reduction, showed differences between LOPI and AP, which were not significant (P=0.411; P=0.464). The cost of LOPI was €2.11 (unit), €211 (cure), and AP €3.77 and €377, respectively.Conclusion: LOPI appeared more effective and less expensive than AP in lowering LDL-C and CVD risk.Trial registration: NCT02898805, September 8, 2016. Keywords: hypercholesterolemia, nutraceuticals, effectiveness, cardiovascular risk reduction
