Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Patients with chronic kidney disease (CKD) have an elevated risk for myocardial infarction (MI) and stroke. Although HMG Co-A reductase inhibitors (“statins”) are effective at preventing cardiovascular (CV) events in patients with non-dialysis-requiring CKD, guidelines conflict on the use of statins in this population. The purpose of this study was to determine the cost-effectiveness of statins for primary cardiovascular prevention in patients with non-dialysis-requiring CKD.
Method: We developed a decision-analytic Markov model. Main outcomes included rates of MI and stroke, discounted quality adjusted life years (QALYs) and life time costs (2010 USD) and associated incremental cost-effectiveness ratios (ICER). Rates of CKD progression were modeled using longitudinal studies of patients with CKD. The possibility of myotoxicity from statins was included in the analysis. Costs of statin therapy included the cost of monthly generic pravastatin along with biannual laboratory monitoring.
Result: For 65 year-olds with mild hypertension and mild-moderate (stage 3) CKD, statin therapy increased lifetime costs in men by $6,210 and in women by $6,855 and led to a gain of 0.12 and 0.07 QALYs in men and women, respectively. Statin therapy reduced the combined rate of MI and stroke, improving outcomes at a cost of $53,085 per QALY for men and $105,788 per QALY in women. The health and economic benefits of statins varied according to age and baseline cardiovascular risk, with the cost per QALY gained higher in younger patients with lower cardiovascular risk.
Conclusion: Use of statins could lead to modest absolute reductions in cardiovascular disease in patients with CKD due to their high underlying risk of cardiac events; however, these gains are partially offset by a modest elevated risk of statin-induced rhabdomyolysis . Statin use in older men with CKD compares favorably to other interventions considered cost effective. In younger men and women with CKD, use of statins is less efficient due to their lower risk of CV events. Statin use is more favorable in all cohorts when low cost generics are available.