Cost-effectiveness of the use of low- and high-potency statins in people at low cardiovascular risk
Cost-effectiveness of the use of low- and high-potency statins in people at low cardiovascular risk
复制标题
DOI：
10.1503/cmaj.101281
复制
发表时间：
2011-11-08
影响因子：
14.6
通讯作者：
Manns, Braden
中科院分区：
文献类型：
--
作者：
Conly, Jon;Clement, Fiona;Manns, Braden
背景：尽管他汀类药物已被证明可以降低低心血管风险患者的心血管事件风险，但其短期内绝对获益较小，这可能会对成本效益产生不利影响。我们试图确定低效他汀类药物和高效他汀类药物对低心血管风险患者的长期成本效益（超出临床试验持续时间），并估计对加拿大公共资助的医疗保健系统的影响。方法：使用马尔可夫模型，我们进行了成本效用分析，其中比较了低效他汀类药物（氟伐他汀、洛伐他汀、普伐他汀和辛伐他汀）和 在模拟的低风险患者队列中，使用高效他汀类药物（阿托伐他汀和瑞舒伐他汀），并在一生中不使用他汀类药物。模型结果包括成本（以 2010 年加元为单位）、获得的质量调整生命年 (QALY) 以及获得的每个 QALY 的成本。 结果：在一生中，不使用他汀类药物治疗低心血管风险患者的成本估计约为 10 100 美元，使用低效他汀类药物为 15 200 美元，使用高效他汀类药物为 16 400 美元。使用高效他汀类药物（对比无他汀类药物）获得的每个 QALY 成本为 21 300 美元；人们认为使用低效他汀类药物在经济上没有吸引力。这些结果对于敏感性分析来说是稳健的，尽管当假设使用他汀类药物的获益持续时间少于 10 年时，它们的使用在经济上没有吸引力。解释：在低心血管风险患者中使用高效他汀类药物与每 QALY 获得的成本相关，按照当前标准，假设使用他汀类药物的益处将持续至少 10 年，则该成本在经济上具有吸引力。然而，他汀类药物的总体支出将是巨大的，政策制定者应仔细考虑这种做法的后果。
Background: Although statins have been shown to re duce the risk of cardiovascular events in patients at low cardiovascular risk, their absolute benefit is small in the short term, which may adversely affect cost-effectiveness. We sought to determine the long-term cost-effectiveness (beyond the duration of clinical trials) of low-and high-potency statins in patients at low cardiovascular risk and to estimate the impact on Canada's publicly funded health care system.Methods: Using Markov modelling, we performed a cost-utility analysis in which we compared low-potency statins (fluvastatin, lovastatin, pravastatin and simvastatin) and high-potency statins (atorvastatin and rosuvastatin) with no statins in a simulated cohort of low-risk patients over a lifetime horizon. Model outcomes included costs (in 2010 Canadian dollars), quality-adjusted life-years (QALYs) gained and the cost per QALY gained.Results: Over a lifetime horizon, the cost of managing a patient at low cardiovascular risk was estimated to be about $10 100 without statins, $15 200 with low-potency statins and $16 400 with high-potency statins. The cost per QALY gained with high-potency statins (v. no statins) was $21 300; the use of low-potency statins was not considered economically attractive. These results were robust to sensitivity analyses, although their use be came economically unattractive when the duration of benefit from statin use was assumed to be less than 10 years.Interpretation: Use of high-potency statins in patients at low cardiovascular risk was associated with a cost per QALY gained that was economically attractive by current standards, assuming that the benefit from statin use would continue for at least 10 years. However, the overall expenditure on statins would be substantial, and the ramifications of this practice should be carefully considered by policy-makers.