Graduate School of Public Health, Institute of Health Services Research, Yonsei University, Seoul, Korea.
Clin Ther. 2009 Dec;31(12):2919-30; discussion 2916-8. doi: 10.1016/j.clinthera.2009.12.013.
BACKGROUND: Although hyperlipidemia is well recognized as a risk factor for cardiovascular disease (CVD), there has been no appraisal of the economic impact of statin therapy in Korea. OBJECTIVE: The aim of this model analysis was to determine the cost-effectiveness of statin therapy versus no treatment for the primary prevention of CVD over a lifetime in Korea, from a health care system perspective. METHODS: We developed the Korean Individual-Microsimulation Model for Cardiovascular Health Interventions (KIMCHI), an epidemiologic and economic Markov model of first-onset CVD in Korea in which all individuals began the simulation in the health state alive without CVD, and moved among the 4 health states (alive without CVD, alive with CVD, dead from CVD, and dead from non-CVD causes) in yearly cycles for any specified time horizon, up to 40 years. KIMCHI was populated with 372 subjects from the 2005 Korean National Health and Nutrition Examination Survey (KNHNES) who were aged > or =45 years, did not have a history of myocardial infarction or ischemic stroke, and met current Korean reimbursement criteria for treatment with lipid-lowering medications. The probability of first-onset CVD was estimated for each study participant individually, based on an Asian population-specific risk equation that relied on an individual's sex, age, serum total cholesterol, systolic blood pressure, current smoking status, diabetes mellitus status, and body mass index. Statin treatment was represented by a hybrid of atorvastatin and simvastatin (the most popular statins in Korea), the lipid-modifying effects of which were de rived from a published meta-analysis. Data regarding utilities and costs of CVD (both those covered and not covered by insurance) were derived from published local sources. RESULTS: In the base case, the estimated incremental costutility ratio was 15,134,284 Korean won (KRW) per quality-adjusted life-year (QALY) gained, and the estimated incremental cost-effectiveness ratio was 20,657,829 KRW per life-year gained (LYG) (1200 KRW approximately US $1). Based on a willingness-to-pay (WTP) threshold of 30 million KRW per QALY saved, there was a 93.7% probability that statin therapy would be cost-effective. Given a WTP threshold of 20 million KRW per QALY, there was a 53.8% probability of being cost-effective. The probabilities at WTP thresholds of 30 and 20 million KRW per LYG were 62.4% and 25.8%, respectively. CONCLUSIONS: Based on this analysis using data from the 2005 KNHNES and the KIMCHI model, statin therapy is likely to be cost-effective for the primary prevention of CVD among Koreans aged > or =45 years. The probability of being cost-effective was greater at a threshold of 30 million KRW per QALY (93.7%) than at 20 million KRW per QALY (53.8%).
背景：尽管高脂血症已被明确认为是心血管疾病（CVD）的一个风险因素，但在韩国，尚未评估他汀类药物治疗的经济影响。
目的：本模型分析旨在从医疗保健系统的角度，确定在韩国，他汀类药物治疗与不治疗在预防 CVD 方面的终生成本效益。
方法：我们开发了韩国个体微观模拟心血管健康干预模型（KIMCHI），这是一个韩国首发 CVD 的流行病学和经济 Markov 模型，其中所有个体都从无 CVD 的健康状态开始模拟，并且每年在 4 种健康状态（无 CVD 存活、有 CVD 存活、CVD 死亡、非 CVD 死亡）之间移动，任何特定的时间范围长达 40 年。KIMCHI 采用了来自 2005 年韩国国家健康与营养调查（KNHNES）的 372 名年龄> =45 岁的个体，他们没有心肌梗死或缺血性中风病史，并且符合当前韩国降低血脂药物治疗的报销标准。根据个体的性别、年龄、血清总胆固醇、收缩压、当前吸烟状况、糖尿病状况和体重指数，为每位研究参与者单独估算首发 CVD 的概率。他汀类药物治疗代表了阿托伐他汀和辛伐他汀（韩国最受欢迎的他汀类药物）的混合使用，其降脂效果源自已发表的荟萃分析。关于 CVD 的效用和成本（包括保险涵盖和不涵盖的）的数据来自已发表的本地来源。
结果：在基线情况下，估计的增量成本效用比为每获得 1 个质量调整生命年（QALY）增加 15134284 韩元（KRW），估计的增量成本效果比为每获得 1 个生命年（LYG）增加 20657829 KRW（1200 KRW 约为 1 美元）。基于节省每 QALY 3000 万韩元的意愿支付（WTP）阈值，他汀类药物治疗有 93.7%的可能性是具有成本效益的。基于每 QALY 2000 万韩元的 WTP 阈值，他汀类药物治疗有 53.8%的可能性具有成本效益。基于 WTP 阈值为 3000 万和 2000 万韩元每 LYG 的概率分别为 62.4%和 25.8%。
结论：基于使用 2005 年 KNHNES 和 KIMCHI 模型的数据进行的这项分析，他汀类药物治疗可能对韩国年龄> =45 岁人群的 CVD 一级预防具有成本效益。在 WTP 阈值为每 QALY 3000 万韩元（93.7%）时，具有成本效益的可能性大于每 QALY 2000 万韩元（53.8%）。
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