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Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease
Kevin F Erickson1, Sohan Japa, Douglas K Owens
1Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA. kevine1@stanford.edu
Insights
Low-cost statins are cost-effective for preventing heart attacks and strokes in patients with chronic kidney disease (CKD). While statins reduce cardiovascular disease (CVD) risk, potential side effects and competing risks slightly offset these benefits.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Health Economics
Background:
- Patients with chronic kidney disease (CKD) face a significantly higher risk of myocardial infarction (MI) and stroke.
- Statins (HMG Co-A reductase inhibitors) show potential for preventing cardiovascular events in non-dialysis CKD patients.
- Adverse drug effects and competing risks in CKD patients necessitate careful evaluation of statin therapy's net benefit.
Purpose of the Study:
- To assess the cost-effectiveness of statins for primary prevention of MI and stroke in individuals with CKD.
- To analyze the economic value of statin therapy in the context of elevated cardiovascular disease (CVD) risk in CKD patients.
Main Methods:
- A decision-analytic model was developed to simulate CKD and CVD progression.
- The model evaluated the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD.
- Key outcomes included MI and stroke rates, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios.
Main Results:
- For a 65-year-old man with hypertension and mild-to-moderate CKD, statins increased costs by $1,800 and gained 0.10 QALYs ($18,000 per QALY).
- For 65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained).
- Cost-effectiveness was sensitive to rhabdomyolysis rates and drug costs, with higher retail prices reducing economic benefits, especially in lower-risk patients.
Conclusions:
- Statins effectively reduce absolute CVD risk in patients with CKD, though gains are partly offset by rhabdomyolysis risk and competing risks from progressive CKD.
- Low-cost generic statins demonstrate cost-effectiveness for primary CVD prevention in individuals with mild-to-moderate CKD and hypertension.
- The economic value of statins is maximized when using low-cost generic formulations, particularly in patient populations with significant CVD risk.
Objectives:
The authors sought to evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD).
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
Although statins reduce absolute CVD risk in patients with CKD, the 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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