Health Economics Assessment of Statin Therapy Initiation Thresholds for Atherosclerosis Prevention in China: a Cost-Effectiveness Analysis

Background The latest revised Chinese guidelines for the management of dyslipidemia have lowered the 10-year risk threshold for initiating statins for primary prevention of atherosclerotic heart disease. The aim of this study was to examine the negative impact of different statin treatment initiation thresholds on diabetes in a Chinese population and to assess their health economics value. Methods In this study, we constructed an event probability-based Microsimulation model to assess the health economics value of statin therapy. The model was based on the Prediction for atherosclerotic cardio-vascular disease (ASCVD) risk in China (China-PAR) and used data from a nationally representative survey and published meta-analysis of the Chinese middle-aged and elderly population as input. We evaluated four different strategies: a 7.5% 10-year risk threshold strategy, a guideline strategy, a 15% 10-year risk threshold strategy, and a 20% 10-year risk threshold strategy. Additionally, we calculated the incremental cost per quality-adjusted life year (QALY) obtained for each strategy to better understand the economics of the various strategies. Result 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. Conclusion The current 10-year ASCVD risk thresholds used in China’s dyslipidemia management guidelines are cost-effective in preventing ASCVD events and should be maintained with the current statin initiation thresholds. Relaxing the initiation threshold as willingness to pay increases would be more cost-effective.