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Cost-effectiveness of lipid lowering with statins and ezetimibe in chronic kidney disease

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  • Iryna Schlackow
  • Seamus Kent
  • William Herrington
  • Jonathan Emberson
  • Richard Haynes
  • Christina Reith
  • Rory Collins
  • Martin J Landray
  • Alastair Gray
  • Colin Baigent
  • Borislava Mihaylova
  • SHARP Collaborative Group (Bo Feldt-Rasmussen, member)
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Statin-based treatments reduce cardiovascular disease (CVD) risk in patients with non-dialysis chronic kidney disease (CKD), but it is unclear which regimen is the most cost-effective. We used the Study of Heart and Renal Protection (SHARP) CKD-CVD policy model to evaluate the effect of statins and ezetimibe on quality-adjusted life years (QALYs) and health care costs in the United States (US) and the United Kingdom (UK). Net costs below $100,000/QALY (US) or £20,000/QALY (UK) were considered cost-effective. We investigated statin regimens with or without ezetimibe 10 mg. Treatment effects on cardiovascular risk were estimated per 1-mmol/L reduction in low-density lipoprotein (LDL) cholesterol as reported in the Cholesterol Treatment Trialists' Collaboration meta-analysis, and reductions in LDL cholesterol were estimated for each statin/ezetimibe regimen. In the US, atorvastatin 40 mg ($0.103/day as of January 2019) increased life expectancy by 0.23 to 0.31 QALYs in non-dialysis patients with stages 3B to 5 CKD, at a net cost of $20,300 to $78,200/QALY. Adding ezetimibe 10 mg ($0.203/day) increased life expectancy by an additional 0.05 to 0.07 QALYs, at a net cost of $43,600 to $91,500/QALY. The cost-effectiveness findings and policy implications in the UK were similar. In summary, in patients with non-dialysis-dependent CKD, the evidence suggests that statin/ezetimibe combination therapy is a cost-effective treatment to reduce the risk of CVD.

Original languageEnglish
JournalKidney International
Volume96
Issue number1
Pages (from-to)170-179
Number of pages10
ISSN0085-2538
DOIs
Publication statusPublished - Jul 2019
Externally publishedYes

    Research areas

  • Aged, Aged, 80 and over, Cardiovascular Diseases/economics, Cholesterol, LDL/blood, Cost-Benefit Analysis, Drug Therapy, Combination/economics, Ezetimibe/economics, Female, Health Care Costs/statistics & numerical data, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/economics, Life Expectancy, Male, Middle Aged, Models, Economic, Quality-Adjusted Life Years, Renal Insufficiency, Chronic/blood, United Kingdom/epidemiology, United States/epidemiology

ID: 60986239