Abstract
Background
Evidence suggests that statin therapy reduces the rate of cardiovascular events among
patients with low lipid levels but elevated C-reactive protein levels. However, no
cost-effectiveness analyses have been performed to assist in determining whether large-scale
randomized trials are merited to test this hypothesis.
Methods
We used a Markov model to estimate the benefits, costs, and incremental cost-effectiveness
of C-reactive protein screening followed by targeted statin therapy for elevated C-reactive
protein levels, compared with dietary counseling alone, for the primary prevention
of cardiovascular events among patients with low-density lipoprotein cholesterol levels
<149 mg/dL. All costs were in 2000 U.S. dollars.
Results
The potential incremental cost-effectiveness ratio for screening followed by statin
therapy compared with no screening and no statin therapy was $48,100 per quality-adjusted
life-year (QALY) for 58-year-old men and $94,400 per QALY for 58-year-old women. Screening
was most cost-effective for 65-year-old men ($42,600 per QALY) and least cost-effective
for 35-year-old women ($207,300 per QALY). Our results were most sensitive to the
baseline risk of coronary heart disease, the cost of statin therapy, and the efficacy
of statin therapy for preventing myocardial infarction in patients with high C-reactive
protein levels. If a 58-year-old man who smokes and is hypertensive was considered,
screening for C-reactive protein followed by statin therapy would be cost saving if
the cost of statin therapy was reduced to $500 per year. If the cost of statin therapy
was reduced to $1 per day, the cost-effectiveness of screening would be $4900 per
QALY for 58-year-old men and $19,600 per QALY for women of the same age. If the costs
associated with elective revascularization (percutaneous coronary intervention or
coronary artery bypass surgery) were included in the base case analyses, the incremental
cost-effectiveness ratios for screening would be $40,100 per QALY for 58-year-old
men and $87,300 per QALY for women.
Conclusion
A strategy involving C-reactive protein screening to target statin therapy for the
primary prevention of cardiovascular disease among middle-aged patients without overt
hyperlipidemia could be relatively cost-effective and, in some cases, cost saving.
Keywords
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Article info
Publication history
Accepted:
December 10,
2002
Received in revised form:
December 4,
2002
Received:
June 3,
2002
Footnotes
☆Dr. Ridker is a coinventor on a pending patent application filed by the Brigham and Women’s Hospital on the use of markers of inflammation in coronary artery disease.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
