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

<h4>Background</h4>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 initiati...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	David C Boettiger, Pairoj Chattranukulchai, Anchalee Avihingsanon, Romanee Chaiwarith, Suwimon Khusuwan, Matthew G Law, Jeremy Ross, Sasisopin Kiertiburanakul
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ca934aaea5ca4a18bd5c1789b32e3f7e
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:ca934aaea5ca4a18bd5c1789b32e3f7e
record_format	dspace
spelling	oai:doaj.org-article:ca934aaea5ca4a18bd5c1789b32e3f7e2021-12-02T20:08:23ZAtherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.1932-620310.1371/journal.pone.0256926https://doaj.org/article/ca934aaea5ca4a18bd5c1789b32e3f7e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256926https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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 ≥10% (control), ≥7.5% and ≥5%.<h4>Results</h4>A statin initiation threshold of ASCVD risk ≥7.5% resulted in accumulation of 0.015 additional quality-adjusted life-years compared with an ASCVD risk threshold ≥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 ≥5% 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 ≥7.5% becoming cost-effective compared with current practice.<h4>Conclusions</h4>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.David C BoettigerPairoj ChattranukulchaiAnchalee AvihingsanonRomanee ChaiwarithSuwimon KhusuwanMatthew G LawJeremy RossSasisopin KiertiburanakulPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256926 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q David C Boettiger Pairoj Chattranukulchai Anchalee Avihingsanon Romanee Chaiwarith Suwimon Khusuwan Matthew G Law Jeremy Ross Sasisopin Kiertiburanakul Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
description	<h4>Background</h4>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.<h4>Methods</h4>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 ≥10% (control), ≥7.5% and ≥5%.<h4>Results</h4>A statin initiation threshold of ASCVD risk ≥7.5% resulted in accumulation of 0.015 additional quality-adjusted life-years compared with an ASCVD risk threshold ≥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 ≥5% 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 ≥7.5% becoming cost-effective compared with current practice.<h4>Conclusions</h4>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.
format	article
author	David C Boettiger Pairoj Chattranukulchai Anchalee Avihingsanon Romanee Chaiwarith Suwimon Khusuwan Matthew G Law Jeremy Ross Sasisopin Kiertiburanakul
author_facet	David C Boettiger Pairoj Chattranukulchai Anchalee Avihingsanon Romanee Chaiwarith Suwimon Khusuwan Matthew G Law Jeremy Ross Sasisopin Kiertiburanakul
author_sort	David C Boettiger
title	Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
title_short	Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
title_full	Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
title_fullStr	Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
title_full_unstemmed	Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis.
title_sort	atherosclerotic cardiovascular disease thresholds for statin initiation among people living with hiv in thailand: a cost-effectiveness analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/ca934aaea5ca4a18bd5c1789b32e3f7e
work_keys_str_mv	AT davidcboettiger atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT pairojchattranukulchai atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT anchaleeavihingsanon atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT romaneechaiwarith atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT suwimonkhusuwan atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT matthewglaw atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT jeremyross atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis AT sasisopinkiertiburanakul atheroscleroticcardiovasculardiseasethresholdsforstatininitiationamongpeoplelivingwithhivinthailandacosteffectivenessanalysis
_version_	1718375207839727616

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

Ejemplares similares