Yawen Jiang1, Weiyi Ni2. 1. Department of Pharmaceutical and Health Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, Verna and Peter Dauterive Hall (VPD), Suite 210, Los Angeles, CA, 90089-3333, USA. yawenjia@usc.edu. 2. Department of Pharmaceutical and Health Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, Verna and Peter Dauterive Hall (VPD), Suite 210, Los Angeles, CA, 90089-3333, USA.
Abstract
OBJECTIVE: The 2016 Chinese guidelines for the management of dyslipidemia recommended mixed rules that centered around a 10% 10-year risk threshold to initiate statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). The present study aimed to evaluate the cost-effectiveness of the guideline statin-initiation strategy and alternative strategies. METHODS: A decision analytic model using discrete event simulation with event probabilities based on a validated ASCVD risk prediction tool for Chinese was constructed. Risk factor inputs were from the dataset of a nationally representative survey of middle-aged and elderly Chinese. Data of statin treatment effectiveness were from a published meta-analysis. Other key input data were identified from the literature or relevant databases. The strategies we evaluated were the guideline strategy, a 15% 10-year risk threshold strategy and a 20% 10-year risk threshold strategy. After excluding any extended dominance strategies, the incremental costs per quality-adjusted life year (QALY) gained of each strategy was calculated. RESULTS: The 20% 10-year risk threshold strategy was an extended dominance option. The incremental costs per QALY gained from the 15% 10-year risk threshold strategy compared with no treatment and the guideline strategy compared with the 15% 10-year risk threshold strategy were CN¥69,309 and CN¥154,944, respectively. The results were robust in most sensitivity analyses. CONCLUSIONS: The guideline strategy and the 15% 10-year risk threshold strategy are optimal when using the three times and the two times the gross domestic product per capita willingness-to-pay standards, respectively.
OBJECTIVE: The 2016 Chinese guidelines for the management of dyslipidemia recommended mixed rules that centered around a 10% 10-year risk threshold to initiate statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). The present study aimed to evaluate the cost-effectiveness of the guideline statin-initiation strategy and alternative strategies. METHODS: A decision analytic model using discrete event simulation with event probabilities based on a validated ASCVD risk prediction tool for Chinese was constructed. Risk factor inputs were from the dataset of a nationally representative survey of middle-aged and elderly Chinese. Data of statin treatment effectiveness were from a published meta-analysis. Other key input data were identified from the literature or relevant databases. The strategies we evaluated were the guideline strategy, a 15% 10-year risk threshold strategy and a 20% 10-year risk threshold strategy. After excluding any extended dominance strategies, the incremental costs per quality-adjusted life year (QALY) gained of each strategy was calculated. RESULTS: The 20% 10-year risk threshold strategy was an extended dominance option. The incremental costs per QALY gained from the 15% 10-year risk threshold strategy compared with no treatment and the guideline strategy compared with the 15% 10-year risk threshold strategy were CN¥69,309 and CN¥154,944, respectively. The results were robust in most sensitivity analyses. CONCLUSIONS: The guideline strategy and the 15% 10-year risk threshold strategy are optimal when using the three times and the two times the gross domestic product per capita willingness-to-pay standards, respectively.
Authors: Bart S Ferket; Ersen B Colkesen; Jacob J Visser; Sandra Spronk; Roderik A Kraaijenhagen; Ewout W Steyerberg; M G Myriam Hunink Journal: Arch Intern Med Date: 2010-01-11
Authors: Natalia Elizabeth Guarín Téllez; Jairo Alexander Moreno Calderón; Ivan Mauricio Muñoz-Galindo; Jorge Augusto Díaz Rojas; Helbert Orlando Arévalo Roa Journal: Value Health Reg Issues Date: 2016-02-10
Authors: J J Brugts; T Yetgin; S E Hoeks; A M Gotto; J Shepherd; R G J Westendorp; A J M de Craen; R H Knopp; H Nakamura; P Ridker; R van Domburg; J W Deckers Journal: BMJ Date: 2009-06-30