Feng Tianyu, Zhang Xiaolin, Xu Jiaying, Gao Shang, Yu Xihe
School of Public Health, Chongqin Medical University, Chongqing, 400016, Chongqing, China.
School of Public Health, Jilin University, Changchun, 130021, China.
Int J Equity Health. 2025 Jan 24;24(1):31. doi: 10.1186/s12939-025-02391-9.
Recent updates to the Chinese guidelines for dyslipidemia management have reduced the 10-year risk threshold for starting statins in the primary prevention of atherosclerotic heart disease. This study aims to evaluate the potential negative effects of different statin initiation thresholds on diabetes risk in the Chinese population, while also analyzing their health economic implications.
I We developed a microsimulation model based on event probabilities to assess the cost-effectiveness of statin therapy. The model utilized the China-PAR prediction tool for ASCVD risk and incorporated data from a nationally representative survey and published meta-analyses of middle-aged and elderly Chinese populations. Four strategies were evaluated: a 7.5% 10-year risk threshold, the current guideline strategy, and a 15% threshold. For each strategy, we calculated the incremental cost per quality-adjusted life year (QALY) to gain insights into the economic impact of each approach.
The incremental cost per QALY for the 10% 10-year risk threshold strategy, compared to the untreated, was $52,218.75. The incremental cost per QALY for the guideline strategy, compared to the 7.5% 10-year risk threshold strategy, was $464,614.36. These results were robust in most sensitivity analyses.
Maintaining the recommended thresholds outlined in the current guidelines for the management of dyslipidemia may represent a cost-effective option for China at present. Variations in statin prices and the risk of statin-induced diabetes have significant impacts on the cost-effectiveness outcomes.
中国血脂异常管理指南的最新更新降低了在动脉粥样硬化性心脏病一级预防中启动他汀类药物治疗的10年风险阈值。本研究旨在评估不同他汀类药物起始阈值对中国人群糖尿病风险的潜在负面影响，同时分析其健康经济学意义。
我们基于事件概率开发了一个微观模拟模型，以评估他汀类药物治疗的成本效益。该模型利用了中国动脉粥样硬化性心血管疾病（ASCVD）风险预测工具（China-PAR），并纳入了来自全国代表性调查的数据以及已发表的中国中老年人群的荟萃分析数据。评估了四种策略：10年风险阈值为7.5%、当前指南策略以及15%的阈值。对于每种策略，我们计算了每获得一个质量调整生命年（QALY）的增量成本，以深入了解每种方法的经济影响。
与未治疗相比，10年风险阈值为10%的策略每QALY的增量成本为52,218.75美元。与10年风险阈值为7.5%的策略相比，指南策略每QALY的增量成本为464,614.36美元。在大多数敏感性分析中，这些结果都是稳健的。
目前，维持现行血脂异常管理指南中推荐的阈值可能是中国具有成本效益的选择。他汀类药物价格的变化以及他汀类药物诱发糖尿病的风险对成本效益结果有重大影响。
