COST-EFFECTIVENESS OF STATIN THERAPY FOR CHD PREVENTION IN ADULTS WITH ELEVATED C-REACTIVE PROTEIN: IMPLICATIONS OF JUPITER

Purpose: To determine the incremental cost-effectiveness of statin therapy for coronary heart disease (CHD) prevention in adults with elevated C-Reactive Protein (CRP) but low low-density lipoprotein (LDL) cholesterol levels.

Method: A Markov decision model was developed to estimate CHD events (myocardial infarction and angina) in the average adult population in the United States with elevated CRP (≥2 mg/L) and low LDL cholesterol (<130 mg/dL), as described in a recent analysis of the National Health and Nutrition Examination Survey (NHANES).  Event rate data from the recent Justification for the Use of Statins in Primary Prevention:  An Intervention Trial Evaluating Rosuvastatin (JUPITER) were used to compare outcomes in this population with and without statin therapy.  Costs for statin therapy, CHD events, and adverse events were calculated from the societal perspective and were adjusted to 2008 dollars.  Statin costs were based on 80mg generic Simvastatin, equipotent to the dose used in JUPITER.  Patient time costs were also calculated.  Quality-adjusted life years (QALYs) were calculated using nationally representative preference-based utility weights.  Incremental cost-effectiveness (ICE) was calculated using these estimates.  Tornado diagrams were used to determine which factors, when varied by 15%, influenced costs and effectiveness most.  Subsequent one-way sensitivity analyses were performed on the most influential factors.  Probabilistic sensitivity analysis (PSA) was used to determine the probability of cost-effectiveness when all event rates, costs and utilities were drawn randomly from distributions reflecting uncertainty. 

Result: Statin therapy was more costly and more effective for CHD prevention in this population.  Statin therapy cost $53,980 per additional QALY gained.  Statin cost and initial age appeared to introduce the most variability into incremental cost estimates, while the utility of the healthy state introduced the most variability into expected incremental QALYs.  The ICE of statin therapy decreased dramatically as statin cost decreased.  ICE also increased as age at therapy initiation increased.  Based on 10,000 simulations from the PSA, statin therapy was cost-effective 93.89% of the time, using a willingness-to-pay (WTP) threshold of $100,000/QALY.   

Conclusion: Statin therapy appears to be a cost-effective prevention strategy in this population.  Results from this analysis also make a case for early prevention.  The results of this analysis are highly sensitive to statin price.  As generic statin prices fall, this strategy will become cost-effective at lower WTP thresholds.