Health economics assessment of statin therapy initiation thresholds for atherosclerosis prevention in China: a cost-effectiveness analysis

Background: Recent updates to the Chinese guidelines for dyslipidemia management have reduced the 10-year risk threshold for starting statins in the primary prevention of atherosclerotic heart disease. This study aims to evaluate the potential negative effects of different statin initiation thresholds on diabetes risk in the Chinese population, while also analyzing their health economic implications.

Methods: I We developed a microsimulation model based on event probabilities to assess the cost-effectiveness of statin therapy. The model utilized the China-PAR prediction tool for ASCVD risk and incorporated data from a nationally representative survey and published meta-analyses of middle-aged and elderly Chinese populations. Four strategies were evaluated: a 7.5% 10-year risk threshold, the current guideline strategy, and a 15% threshold. For each strategy, we calculated the incremental cost per quality-adjusted life year (QALY) to gain insights into the economic impact of each approach.

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: Maintaining the recommended thresholds outlined in the current guidelines for the management of dyslipidemia may represent a cost-effective option for China at present. Variations in statin prices and the risk of statin-induced diabetes have significant impacts on the cost-effectiveness outcomes.