Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease.
Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease.
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DOI：
10.1016/j.jacc.2012.12.034
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发表时间：
2013-03-26
影响因子：
24
通讯作者：
Goldhaber-Fiebert, Jeremy D.
中科院分区：
文献类型：
--
作者：
Erickson, Kevin F.;Japa, Sohan;Owens, Douglas K.;Chertow, Glenn M.;Garber, Alan M.;Goldhaber-Fiebert, Jeremy D.
评价他汀类药物用于慢性肾脏病（CKD）患者心肌梗死（MI）和卒中一级预防的成本-效果。CKD患者发生MI和卒中的风险升高。尽管HMG辅酶A还原酶抑制剂（“他汀类药物”）可预防不需要透析的CKD患者的心血管事件，但药物不良反应和竞争风险可能会对净效应和临床决策产生重大影响。我们开发了一个CKD和心血管疾病（CVD）的决策分析模型，以确定低成本通用他汀类药物用于高血压和轻中度CKD男性和女性的一级CVD预防的成本效益。结果包括MI和卒中发生率、贴现质量调整生命年（QDs）和终身成本（2010年美元）以及增量成本效果比。对于患有中度高血压和轻度至中度CKD的65岁男性，他汀类药物降低了MI和卒中的合并发生率，产生了0.10 QALY，并增加了1，800美元的成本（每增加QALY 18，000美元）。对于基线心血管风险较低的患者，健康和经济效益较小;对于65岁的女性，他汀类药物产生0.06 QALY，增加成本1，900美元（每增加QALY 33，400美元）。结果对横纹肌溶解率和药物费用敏感。当以平均零售价格获得时，他汀类药物的成本效益较低，特别是在CVD风险较低的患者中。虽然他汀类药物降低了CKD患者的绝对CVD风险，但横纹肌溶解风险增加，以及与进展性CKD相关的竞争风险，部分抵消了这些收益。低成本非专利他汀类药物对于轻中度慢性肾病和高血压患者的心血管疾病一级预防似乎具有成本效益。
To evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD). Patients with CKD have an elevated risk of MI and stroke. Although HMG Co-A reductase inhibitors (“statins”) may prevent cardiovascular events in patients with non-dialysis-requiring CKD, adverse drug effects and competing risks could materially influence net effects and clinical decision-making. We developed a decision-analytic model of CKD and cardiovascular disease (CVD) to determine the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted quality adjusted life years (QALYs) and lifetime costs (2010 USD), and incremental cost-effectiveness ratios. For 65 year-old men with moderate hypertension and mild-to-moderate CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and increased costs by $1,800 ($18,000 per QALY gained). For patients with lower baseline cardiovascular risks, health and economic benefits were smaller; for 65 year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and drug costs. Statins are less cost-effective when obtained at average retail prices, particularly in patients at lower CVD risk. While statins reduce absolute CVD risk in patients with CKD, increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.
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影响因子：
2.1
作者：
Manns, B;Meltzer, D;Donaldson, C
通讯作者：
Donaldson, C
影响因子：
7.2
作者：
McClure, David L.;Valuck, Robert J.;Hokanson, John E.
通讯作者：
Hokanson, John E.
影响因子：
24
作者：
Ridker, Paul M.;MacFadyen, Jean;Glynn, Robert J.
通讯作者：
Glynn, Robert J.
影响因子：
2.7
作者：
Glasser, Stephen P.;Wadley, Virginia;Howard, George
通讯作者：
Howard, George
影响因子：
6.1
作者：
Schwarz, U;Buzello, M;Amann, K
通讯作者：
Amann, K