HMG-CoA還元酵素阻害薬 (Statins) による虚血性心疾患の一次予防の経済的評価

抄録

Objective : To estimate the cost-effectiveness of using statins to prevent coronary heart disease (CHD) in men and women with hypercholesterolemia. Methods : A cost-effectiveness analysis of statins (such as, cerivastatin and pravastatin), by using “do-nothing” as a comparator, was conducted from a payer's point of view, based on a randomized controlled trial. By using a Markov model, life-time benefits (life-year gained) and costs were estimated. In the basic analysis, men and women of 50 years old with hypercholesterolemia (TC level ; 275 mg/ dl) were used. Both benefits and costs were discounted by 5% annually. The robustness of the model was tested by a sensitivity analysis.
Results : The cost per life-year gained with cerivastatin was ¥ 3, 480, 000 for men and ¥ 6, 340, 000 for women, respectively. The cost per life-year gained with pravastatin was ¥ 4, 650, 000 for men and¥ 8, 200, 000 for women, respectively. The incremental cost-effectiveness of cerivastatin compared with pravastatin was negative, indicating a low-cost and high-effect. A sensitivity analysis demonstrated the robustness of these results.
Conclusions : According to the Laupacis's criteria, cholesterol-lowering treatment by statins demonstrated the moderate evidence for adoption and appropriate utilization. Since this study is based on a small randomized controlled trial, several post-marketing surveillance studies will be necessary to confirm the validity.