title: Cost-effectiveness of statin therapy for vascular event prevention in adults with elevated C-reactive protein: implications of JUPITER.
abstract: OBJECTIVE
  High-sensitivity C-reactive protein (hs-CRP) has been explored for use in predicting cardiovascular risk. The recent Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study found that statin therapy reduced cardiovascular events in those with low-density lipoprotein (LDL) cholesterol levels below current treatment thresholds (≤130 mg/dL, 3.4 = mmol/L), but with elevated hs-CRP levels (≥2.0 mg/L). This study examines the cost-effectiveness of statin treatment for individuals with elevated hs-CRP but normal LDL cholesterol.
  
  
  METHODS
  A Markov decision-analytic model was conducted from the U.S. societal perspective. Data from JUPITER were used to estimate rates of myocardial infarction, angina and stroke. Statin costs were based on generic simvastatin 80 mg, equipotent to the rosuvastatin 20 mg dose used in JUPITER. Primary prevention was the focus and secondary prevention was not modeled explicitly. Quality-adjusted life-years (QALYs) were calculated using nationally representative preference-based utility weights. One-way sensitivity analyses and multivariate probabilistic sensitivity analysis were used to explore uncertainty in model parameters as well as estimate the likelihood of cost-effectiveness when all event rates, costs and utilities were drawn randomly from distributions reflecting uncertainty.
  
  
  RESULTS
  Statin therapy cost $10,889/QALY for vascular event prevention in this population. Results were sensitive to the cost of statin treatment. Based on 10,000 simulations, statin therapy was cost-effective in 99.5% of simulations, using a willingness-to-pay threshold of $20,000/QALY, and 100% of simulations using a threshold of $50,000/QALY.
  
  
  CONCLUSIONS
  Treatment with statins in patients with elevated hs-CRP but normal cholesterol appears to be cost-effective. Limitations of this study include the assumption that an equipotent dose of simvastatin resulted in the same risk reduction as rosuvastatin. Further, post-event states simulated the average experience of a patient. Continued statin use, subsequent events and/or heart failure were not explicitly modeled.
authors.affiliation: Pharmaceutical Outcomes Research Program, University of Colorado School of Pharmacy, Aurora, CO 80045, USA. julia.slejko@ucdenver.edu
authors.forename: Julia F
authors.initials: JF
authors.lastname: Slejko
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D018890:Chemoprevention / Q000191:economics / Q000379:methods; D002986:Clinical Trials as Topic / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005464:Fluorobenzenes / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics* / Q000379:methods; D011743:Pyrimidines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome; D015854:Up-Regulation; D014652:Vascular Diseases / Q000097:blood / Q000191:economics / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein