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Statin Rx Cost-Effective Based on C-Reactive Proteins
  By Ed Susman, Contributing Writer, MedPage Today
Published: March 18, 2010
Action Points
* Explain to interested readers that a mathematical model predicts that statin treatments for people with normal low-density lipoprotein cholesterol but elevated levels of C-reactive protein would be cost-effective but could strain Medicare resources.
* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
ATLANTA -- Treating people with normal low-density lipoprotein cholesterol but elevated levels of C-reactive protein with statins would be cost-effective, researchers said here, but they suggested that the practice could strain healthcare resources.
Using data from the landmark JUPITER trial (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin), researchers told colleagues at the American College of Cardiology meeting that the trial "provides compelling evidence that more adults could benefit from statin treatment by preventing vascular adverse events than are presently included in the National Cholesterol Education Program Adult Treatment Panel."
That's because the panel does not address C-reactive protein status as a primary risk factor, said Julia F. Slejko, BA, a PhD candidate at the University of Colorado School of Pharmacy.
"If the NCEP guidelines are expanded to address C-reactive protein, it is estimated that six million to ten million adults would be new statin users, in addition to the 6.5 million adults who are currently statin users," she said at her poster presentation.
Slejko and colleagues set out to determine if treatment would be cost-effective from the societal perspective, using the oft-cited cutoff of $50,000 per quality adjusted life-year.
The difference between this study and others is that stroke prevention was added to coronary heart disease prevention for the purposes of modeling.
The researchers identified a hypothetical 57-year-old individual who would require lifetime statin therapy as the model for the Markov simulation.
Slejko ran the simulation 10,000 times and determined that in 92% of the cases, the cost of a quality adjusted life-year would be less than $50,000. She said the incremental cost-effectiveness ratio in her model would be $40,457.
"This research suggests that statin prevention in those with elevated C-reactive protein is cost-effective," Slejko said. "This may support the hypothesis that expanding the NCEP guidelines would also be cost-effective."
On the other hand, Slejko cautioned that if the guidelines were updated to include C-reactive protein, more than half the new patients would be Medicare beneficiaries.
"Thus the majority of potential new statin therapy costs may be seen as an additional burden to an already strained fund," she said. "An estimation of the entire cost of this approach is needed to inform policymakers."
Some skeptics questioned the researchers' projections.
"Reimbursement of costs for tests and the number of tests and office visits that are likely to be necessary could be underestimated in this model," Raymond Gibbons, MD, of the Mayo Clinic in Rochester, Minn., told MedPage Today. "Realistically, these figures are likely to only apply to a Medicare population."
He said that while the model estimated two to six physician visits a year, a transient test abnormality might require more office visits and more testing than the model anticipates.
On the other hand, Gibbons said the likelihood of six to ten million new patients being added to the treatment algorithm may be exaggerated.
Slejko and Gibbons did not have any disclosures.
Primary source: American College of Cardiology
Source reference:
Slejko J, et al "Statin therapy is cost-effective for vascular event prevention in adults with elevated C-reactive protein: Implications of JUPITER" ACC 2010; Abstract 1030-172.
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