AI Article Synopsis
- A study investigated whether starting statin treatment in patients with coronary artery disease (CAD) who have LDL-C levels between 70-100 mg/dL is cost-effective, following updated guidelines that lower the LDL-C target to 70 mg/dL.
- Using a Markov model, researchers simulated outcomes for CAD patients with a baseline LDL-C of 90 mg/dL, analyzing factors like heart attacks, strokes, treatment costs, and quality of life.
- The results indicated that moderate-intensity statin therapy could provide significant health benefits, achieving an incremental cost-effectiveness ratio of $20,288 per quality-adjusted life year, suggesting that the approach could be cost-effective, especially as a preventive measure in CAD patients.
Article Abstract
Background: The recommended target low-density lipoprotein cholesterol (LDL-C) level for coronary artery disease (CAD) patients has been lowered from 100 to 70 mg/dL in several clinical guidelines for secondary prevention. We aimed to assess whether initiating statin treatment in CAD patients with baseline LDL-C 70-100 mg/dL in Taiwan could be cost-effective.
Methods: A Markov model was developed to simulate a hypothetical cohort of CAD patients with a baseline LDL-C level of 90 mg/dL. The incidence and recurrence of MI and stroke related to specific LDL-C levels as well as the statin effect, mortality rate, and health state utilities were obtained from the literature. The direct medical costs and rate of fatal events were derived from the national claims database. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) was calculated, and sensitivity analyses were performed.
Results: Moderate-intensity statin use, a treatment regimen expected to achieve LDL <70 mg/dL in the base case, resulted in a net gain of 562 QALYs but with an additional expenditure of $11.4 million per 10,000 patients over ten years. The ICER was $20,288 per QALY gained. The probabilities of being cost-effective at willingness-to-pay thresholds of one and three gross domestic product per capita ($24,329 in 2017) per QALY were 51.1% and 94.2%, respectively. Annual drug cost was the most influential factor on the ICER.
Conclusion: Lowering the target LDL-C level from 100 to 70 mg/dL among treatment-naïve CAD patients could be cost-effective given the health benefits of preventing cardiovascular events and deaths.
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| http://dx.doi.org/10.1016/j.jfma.2020.01.010 | DOI Listing |
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