Lost Therapeutic Benefit of Delayed Low-Density Lipoprotein Cholesterol Control in Statin-Treated Patients and Cost-Effectiveness Analysis of Lipid-Lowering Intensification |
| |
| Institution: | 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia;2. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;3. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;4. Amgen Australia Pty Ltd, Sydney, NSW, Australia;5. Amgen Europe GmbH, Rotkreuz ZG, Switzerland;6. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia;1. Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands;2. Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, The Netherlands;3. Faculty of Management Sciences, Open University, Heerlen, The Netherlands;4. Health-Ecore, Zeist, The Netherlands;5. Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands;1. Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia;2. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University;3. Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia;4. QIMR Berghofer Medical Research Institute, Herston, QLD, Australia;5. Metro North Mental Health Service, Herston, QLD, Australia;6. Child and Adolescent Mental Health Services Barwon Health, Geelong, VIC, Australia;7. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia;8. Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia;9. Royal Children’s Hospital, Melbourne, VIC, Australia;10. Murdoch Children’s Research Institute, Melbourne, VIC, Australia;11. Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia;12. School of Population Health, Curtin University, Perth, WA, Australia;13. Caring Futures Institute, Flinders University, Adelaide, SA, Australia;14. Children’s Health, Queensland Hospital and Health Service, University of Queensland, Herston, QLD, Australia;15. Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology, Sydney, NSW, Australia;1. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands;2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;3. Sanofi, Bridgewater, NJ, USA;4. Pfizer Inc, Brussels, Belgium;5. Sanofi, Chilly-Mazarin, France;6. Merck & Co, Kenilworth, NJ, USA;7. Janssen Research & Development, LLC, Titusville, NJ, USA;8. Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Enschede, The Netherlands;1. Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Zuid-Holland, The Netherlands;2. Amsterdam University Medical Center, University of Amsterdam, Noord-Holland, The Netherlands;3. LOGEX b.v., Amsterdam, Noord-Holland, The Netherlands;1. Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA;2. Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA;3. Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands;4. School of Health and Related Research, University of Sheffield, Sheffield, England, UK;5. Global R&D Epidemiology, Janssen R&D, Titusville, NJ, USA;6. Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK;7. Google, San Francisco, CA, USA;8. Kielo Research, Zug, Switzerland |
| |
| Abstract: | ObjectivesAttainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health economic impact of delayed lipid-lowering intensification from an Australian healthcare and societal perspective.MethodsA lifetime Markov cohort model (n = 1000) estimating the impact on coronary heart disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients with uncontrolled LDL-C, at moderate to high risk of CHD with no delay or after a 5-year delay, compared with standard of care (no intensification), starting at age 40 years. Intensification was tested with high-intensity statins or statins + ezetimibe. LDL-C levels were extracted from a primary care cohort. CHD risk was estimated using the pooled cohort equation. The effect of cumulative exposure to LDL-C on CHD risk was derived from Mendelian randomization data. Outcomes included CHD events, quality-adjusted life-years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICERs). All outcomes were discounted annually by 5%.ResultsOver the lifetime horizon, compared with standard of care, achieving LDL-C control with no delay with high-intensity statins prevented 29 CHD events and yielded 30 extra QALYs (ICERs AU$13 205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20 270/QALY) with a 5-year delay. For statins + ezetimibe, no delay prevented 53 CHD events and gave 45 extra QALYs (ICER AU$37 271/QALY) versus 40 CHD events and 29 QALYs (ICER of AU$44 218/QALY) after a 5-year delay.ConclusionsDelaying attainment of LDL-C goals translates into lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in statin-treated patients. |
| |
| Keywords: | cost-effectiveness lipid lowering lost therapeutic benefit primary prevention |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
