Department of Pharmaceutical and Health Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, Verna and Peter Dauterive Hall (VPD), Suite 210, Los Angeles, CA, 90089-3333, USA.
Pharmacoeconomics. 2019 Jul;37(7):943-952. doi: 10.1007/s40273-019-00791-8.
The 2016 Chinese guidelines for the management of dyslipidemia recommended mixed rules that centered around a 10% 10-year risk threshold to initiate statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). The present study aimed to evaluate the cost-effectiveness of the guideline statin-initiation strategy and alternative strategies.
A decision analytic model using discrete event simulation with event probabilities based on a validated ASCVD risk prediction tool for Chinese was constructed. Risk factor inputs were from the dataset of a nationally representative survey of middle-aged and elderly Chinese. Data of statin treatment effectiveness were from a published meta-analysis. Other key input data were identified from the literature or relevant databases. The strategies we evaluated were the guideline strategy, a 15% 10-year risk threshold strategy and a 20% 10-year risk threshold strategy. After excluding any extended dominance strategies, the incremental costs per quality-adjusted life year (QALY) gained of each strategy was calculated.
The 20% 10-year risk threshold strategy was an extended dominance option. The incremental costs per QALY gained from the 15% 10-year risk threshold strategy compared with no treatment and the guideline strategy compared with the 15% 10-year risk threshold strategy were CN¥69,309 and CN¥154,944, respectively. The results were robust in most sensitivity analyses.
The guideline strategy and the 15% 10-year risk threshold strategy are optimal when using the three times and the two times the gross domestic product per capita willingness-to-pay standards, respectively.
2016 年中国血脂异常管理指南推荐了混合规则，以 10 年 10%的风险阈值为中心，启动他汀类药物用于动脉粥样硬化性心血管疾病（ASCVD）的一级预防。本研究旨在评估指南起始他汀类药物策略和替代策略的成本效益。
使用基于验证的中国 ASCVD 风险预测工具的离散事件模拟的决策分析模型进行构建，该模型具有基于事件概率的离散事件模拟。风险因素输入来自全国代表性的中老年人群调查数据集。他汀类药物治疗效果数据来自已发表的荟萃分析。其他关键输入数据来自文献或相关数据库。我们评估的策略是指南策略、15%10 年风险阈值策略和 20%10 年风险阈值策略。排除任何扩展优势策略后，计算每种策略的每增加一个质量调整生命年（QALY）的增量成本。
20%10 年风险阈值策略是一种扩展优势选择。与不治疗相比，15%10 年风险阈值策略与无治疗相比和与指南策略相比，每增加一个 QALY 的增量成本分别为 69309 元人民币和 154944 元人民币。在大多数敏感性分析中，结果都是稳健的。
在使用三倍和两倍人均国内生产总值支付意愿标准时，指南策略和 15%10 年风险阈值策略分别是最优的。
