4.4 Article

Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States

期刊

出版社

JOHN WILEY & SONS LTD
DOI: 10.1002/jia2.25690

关键词

HIV; cardiovascular disease; statin; cost‐ effectiveness; United States; antiretroviral therapy

资金

  1. Danish National Research Foundation (CHIP) [DNRF126]
  2. Danish National Research Foundation (PERSIMUNE) [DNRF126]
  3. Highly Active Antiretroviral Therapy Oversight Committee (HAARTOC)
  4. European Agency for the Evaluation of Medicinal Products
  5. United States Food and Drug Administration
  6. patient community and pharmaceutical companies with licensed anti-HIV drugs in the European Union: AbbVie
  7. Bristol-Myers Squibb
  8. Gilead Sciences Inc.
  9. ViiV Healthcare
  10. Merck Co Inc.
  11. Janssen Pharmaceuticals
  12. Dutch Ministry of Health, Welfare and Sport through the Center for Infectious Disease Control of the National Institute for Public Health and the Environment
  13. Agence nationale de recherches sur le sida et les hepatites virales (ANRS) [7]
  14. Australian HIV Observational Database (AHOD) as part of the Asia Pacific HIV Observational Database, a programme of The Foundation for AIDS Research, amfAR
  15. U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) [U01-AI069907]
  16. Merck Sharp Dohme
  17. Gilead Sciences
  18. Boehringer Ingelheim
  19. Janssen-Cilag
  20. Australian Government Department of Health and Ageing
  21. Fondo de Investigacion Sanitaria [FIS 99/0887]
  22. Fundacion para la Investigacion y la Prevencion del SIDA en Espana [FIPSE 3171/00]
  23. National Institute of Allergy and Infectious Diseases, National Institutes of Health [5U01AI042170-10, 5U01AI046362-03]
  24. European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant [260694]
  25. Janssen RD
  26. Merck and Co. Inc.
  27. Pfizer Inc.
  28. GlaxoSmithKline LLC, (Swiss National Science Foundation) [108787]
  29. AbbVie
  30. GlaxoSmithKline
  31. Pfizer
  32. Swiss HIV Cohort Study - Swiss National Science Foundation [148522]
  33. SHCS Research Foundation

向作者/读者索取更多资源

This study evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among people living with HIV (PLHIV) in the United States. It found that pravastatin was more cost-effective compared to no statin use, while pitavastatin may be more costly but more effective than pravastatin.
Background Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States. Methods We developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years. Results Persons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal. Conclusions Pravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.

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