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Cost-utility analysis of using high-intensity statin among post-hospitalized acute coronary syndrome patients

Pramitha Esha Nirmala Dewi1,2, Montarat Thavorncharoensap3,4, Bangunawati Rahajeng5

  • 1Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. pramithaesha@umy.ac.id.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|April 14, 2024
PubMed

Insights

High-intensity statin (HIS) therapy is a cost-effective secondary prevention strategy for acute coronary syndrome (ACS) patients in Indonesia, improving quality-adjusted life years (QALYs) within the national willingness-to-pay threshold.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Public Health Policy

Background:

  • Indonesian National Insurance currently does not cover high-intensity statins (HIS) for secondary prevention in acute coronary syndrome (ACS) patients.
  • A cost-utility analysis is essential to determine the cost-effectiveness of HIS versus low-to-moderate-intensity statins (LMIS) for ACS patients.
  • This study evaluates the long-term economic impact of HIS in post-hospitalized ACS patients in Indonesia.

Purpose of the Study:

  • To estimate the cost-utility of long-term high-intensity statin (HIS) treatment for post-hospitalized acute coronary syndrome (ACS) patients in Indonesia.
  • To compare the cost-effectiveness of HIS against current practice (low-to-moderate-intensity statins, LMIS).
  • To inform Indonesian healthcare policy regarding secondary prevention after ACS.

Main Methods:

  • A lifetime Markov model was employed to predict events, costs, and quality-adjusted life years (QALYs) from a payer perspective.
  • A systematic review synthesized data on treatment-specific event probabilities, survival rates, quality of life, and healthcare expenses in Indonesia.
  • Probabilistic sensitivity analysis (PSA) and deterministic sensitivity analyses (tornado diagram) were conducted to assess model robustness.

Main Results:

  • High-intensity statin (HIS) treatment was found to increase per-patient QALYs and healthcare expenditures compared to LMIS.
  • The incremental cost-effectiveness ratio (ICER) for HIS was 31,843,492 IDR per QALY gained.
  • This ICER falls below Indonesia's willingness-to-pay (WTP) threshold for life-saving treatments.

Conclusions:

  • High-intensity statin (HIS) therapy is a cost-effective intervention for post-hospitalized ACS patients in Indonesia from a payer's perspective.
  • The cost-effectiveness is demonstrated by an ICER of 31,843,492 IDR per QALY gained.
  • This finding supports the consideration of HIS for secondary prevention in ACS patients within the Indonesian healthcare system.
Abstract

Keywords:
Acute coronary syndromeCost per quality-adjusted life yearCost–utility analysisHigh-intensity stain

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