Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands

Folgerdiena M de Vries; Petra Denig; Sipke T Visser; Eelko Hak; Maarten J Postma

doi:10.1016/j.jval.2013.12.010

Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands

Value Health. 2014 Mar;17(2):223-30. doi: 10.1016/j.jval.2013.12.010.

Authors

Folgerdiena M de Vries¹, Petra Denig², Sipke T Visser³, Eelko Hak³, Maarten J Postma³

Affiliations

¹ Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands. Electronic address: F.M.de.Vries@rug.nl.
² Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands.

PMID: 24636380
DOI: 10.1016/j.jval.2013.12.010

Abstract

Background: Statins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes.

Objectives: The objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking nonadherence, baseline risk, and age into account.

Methods: A cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment (GIANTT) database, using the United Kingdom Prospective Diabetes Study risk engine. Statin adherence was measured as pill days covered in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the health care payers' perspective.

Results: For an average patient aged 60 years, the base case, statin treatment was highly cost-effective at €2245 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost €100,000 per QALY to almost being cost saving. Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective (weighted cost-effectiveness of almost €60,000 per QALY).

Conclusions: Despite the nonadherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Because of large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.

Keywords: cardiovascular risk management; cost-effectiveness; statins; type 2 diabetes.

MeSH terms

Adult
Age Factors
Aged
Cardiovascular Diseases / economics
Cardiovascular Diseases / etiology
Cardiovascular Diseases / prevention & control*
Cost-Benefit Analysis
Databases, Factual
Diabetes Mellitus, Type 2 / drug therapy*
Diabetes Mellitus, Type 2 / economics
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Male
Markov Chains
Medication Adherence*
Middle Aged
Netherlands
Primary Prevention / economics
Primary Prevention / methods*
Quality-Adjusted Life Years
Risk Factors

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors