Cost-effectiveness of statins, berberine, and combination for primary cardiovascular disease prevention in Scotland

We aim to estimate and compare the cost-effectiveness of statins, berberine, and their combined use for primary cardiovascular disease (CVD) prevention. The Scottish CVD Policy Model was used to predict long-term health and cost outcomes in Scottish adults aged 40 years or older without pre-existing CVD. Intervention and cost inputs were sourced from published literature and health service cost data. The primary outcome measure was the lifetime incremental cost-effectiveness ratio (ICER), evaluated as cost per quality-adjusted life year (QALY) gained. Five strategies were analyzed for individuals with ASSIGN risk scores ≥20% and ≥10%: no intervention, atorvastatin 20 mg/day, berberine 1000 mg/day, simvastatin 20 mg plus berberine 1500 mg/day, and simvastatin 20 mg plus berberine 900 mg/day. All intervention strategies were cost-effective, compared to no intervention, at the threshold of ICER of £20,000 per QALY. Compared to statins, berberine was less cost-effective, but the combined interventions remained cost-effective. Notably, when using drug costs from China (reflecting lower berberine prices), berberine and the combined interventions were preferable to statins alone. Statins, berberine, and combined interventions are all cost-effective options for primary CVD prevention. Berberine could be considered a valuable alternative or complementary therapy, particularly if its price decreases below that of statins.