Journal Article

Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis

Avihingsanon, Anchalee, Boettiger, David C., Khusuwan, Suwimon, Law, Matthew G., Kiertiburanakul, Sasisopin, Chaiwarith, Romanee, Chattranukulchai, Pairoj, Ross, Jeremy

2021

Overview

People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (ASCVD) compared to their uninfected peers. Expanding statin use may help alleviate this burden. We evaluated the cost-effectiveness of reducing the recommend statin initiation threshold for primary ASCVD prevention among PLHIV in Thailand. Our decision analytic microsimulation model randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database (data collected between 1/January/2013 and 1/September/2019). Direct medical costs and quality-adjusted life-years were assigned in annual cycles over a lifetime horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. The study population included PLHIV aged 35-75 years, without ASCVD, and receiving antiretroviral therapy. Statin initiation thresholds evaluated were 10-year ASCVD risk [greater than or equal to]10% (control), [greater than or equal to]7.5% and [greater than or equal to]5%. A statin initiation threshold of ASCVD risk [greater than or equal to]7.5% resulted in accumulation of 0.015 additional quality-adjusted life-years compared with an ASCVD risk threshold [greater than or equal to]10%, at an extra cost of 3,539 Baht ( US113), giving an incremental cost-effectiveness ratio of 239,000 Baht ( US7,670)/quality-adjusted life-year gained. The incremental cost-effectiveness ratio comparing ASCVD risk [greater than or equal to]5% to [greater than or equal to]7.5% was 349,000 Baht ( US11,200)/quality-adjusted life-year gained. At a willingness-to-pay threshold of 160,000 Baht ( US5,135)/quality-adjusted life-year gained, a 30.8% reduction in the average cost of low/moderate statin therapy led to the ASCVD risk threshold [greater than or equal to]7.5% becoming cost-effective compared with current practice. Reducing the recommended 10-year ASCVD risk threshold for statin initiation among PLHIV in Thailand would not currently be cost-effective. However, a lower threshold could become cost-effective with greater preference for cheaper statins.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / AIDS / Annual cycles / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Arteriosclerosis / Atherosclerosis / Cardiovascular diseases / Complications and side effects / Cost analysis / Decision analysis / Health risks / HIV / HIV infection / Human immunodeficiency virus / Medicine and Health Sciences / Patient outcomes / People and Places / Population studies / Review boards / Risk factors / Risk management / Social Sciences / Statins / Thresholds