Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK.
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, UK.
Kidney Int. 2019 Jul;96(1):170-179. doi: 10.1016/j.kint.2019.01.028. Epub 2019 Mar 12.
Statin-based treatments reduce cardiovascular disease (CVD) risk in patients with non-dialysis chronic kidney disease (CKD), but it is unclear which regimen is the most cost-effective. We used the Study of Heart and Renal Protection (SHARP) CKD-CVD policy model to evaluate the effect of statins and ezetimibe on quality-adjusted life years (QALYs) and health care costs in the United States (US) and the United Kingdom (UK). Net costs below $100,000/QALY (US) or £20,000/QALY (UK) were considered cost-effective. We investigated statin regimens with or without ezetimibe 10 mg. Treatment effects on cardiovascular risk were estimated per 1-mmol/L reduction in low-density lipoprotein (LDL) cholesterol as reported in the Cholesterol Treatment Trialists' Collaboration meta-analysis, and reductions in LDL cholesterol were estimated for each statin/ezetimibe regimen. In the US, atorvastatin 40 mg ($0.103/day as of January 2019) increased life expectancy by 0.23 to 0.31 QALYs in non-dialysis patients with stages 3B to 5 CKD, at a net cost of $20,300 to $78,200/QALY. Adding ezetimibe 10 mg ($0.203/day) increased life expectancy by an additional 0.05 to 0.07 QALYs, at a net cost of $43,600 to $91,500/QALY. The cost-effectiveness findings and policy implications in the UK were similar. In summary, in patients with non-dialysis-dependent CKD, the evidence suggests that statin/ezetimibe combination therapy is a cost-effective treatment to reduce the risk of CVD.
基于他汀类药物的治疗可降低非透析慢性肾脏病（CKD）患者的心血管疾病（CVD）风险，但哪种治疗方案最具成本效益尚不清楚。我们使用心脏和肾脏保护研究（SHARP）CKD-CVD 政策模型在美国（US）和英国（UK）评估他汀类药物和依折麦布对质量调整生命年（QALY）和医疗保健成本的影响。低于每 QALY（美国）$100,000 或每 QALY（英国）£20,000 的净成本被认为具有成本效益。我们研究了有或没有依折麦布 10 mg 的他汀类药物治疗方案。根据胆固醇治疗试验者协作荟萃分析报告，每降低 1mmol/L 低密度脂蛋白（LDL）胆固醇估计对心血管风险的治疗效果，并且为每种他汀类药物/依折麦布治疗方案估计 LDL 胆固醇的降低。在美国，阿托伐他汀 40 mg（截至 2019 年 1 月每天$0.103）可使 3B 期至 5 期 CKD 非透析患者的预期寿命延长 0.23 至 0.31 QALY，净成本为$20,300 至$78,200/QALY。添加依折麦布 10 mg（每天$0.203）可使预期寿命再延长 0.05 至 0.07 QALY，净成本为$43,600 至$91,500/QALY。英国的成本效益发现和政策影响相似。总之，在非透析依赖型 CKD 患者中，证据表明他汀类药物/依折麦布联合治疗是降低 CVD 风险的一种具有成本效益的治疗方法。
