title: Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease.
abstract: OBJECTIVE
  The authors sought to evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD).
  
  
  BACKGROUND
  Patients with CKD have an elevated risk of MI and stroke. Although HMG Co-A reductase inhibitors (“statins”) may prevent cardiovascular events in patients with non–dialysis-requiring CKD, adverse drug effects and competing risks could materially influence net effects and clinical decision-making.
  
  
  METHODS
  We developed a decision-analytic model of CKD and cardiovascular disease (CVD) to determine the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted quality-adjusted life years (QALYs) and lifetime costs (2010 USD), and incremental cost-effectiveness ratios.
  
  
  RESULTS
  For 65-year-old men with moderate hypertension and mild-to-moderate CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and increased costs by $1,800 ($18,000 per QALY gained). For patients with lower baseline cardiovascular risks, health and economic benefits were smaller; for 65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and drug costs. Statins are less cost-effective when obtained at average retail prices, particularly in patients at lower CVD risk.
  
  
  CONCLUSIONS
  Although statins reduce absolute CVD risk in patients with CKD, the increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA. kevine1@stanford.edu
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Erickson
authors.forename: Sohan
authors.initials: S
authors.lastname: Japa
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy / Q000191:economics; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008390:Markov Chains; D009203:Myocardial Infarction / Q000191:economics* / Q000517:prevention & control*; D017035:Pravastatin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D011322:Primary Prevention / Q000191:economics; D019057:Quality-Adjusted Life Years; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000191:economics; D012306:Risk; D012737:Sex Factors; D020521:Stroke / Q000191:economics* / Q000517:prevention & control*; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin