Health Economics Assessment of Statin Therapy Initiation Thresholds for Atherosclerosis Prevention in China: a Cost-Effectiveness Analysis

Background The latest revised Chinese guidelines for the management of dyslipidemia have lowered the 10-year risk threshold for initiating statins for primary prevention of atherosclerotic heart disease. The aim of this study was to examine the negative impact of different statin treatment initiation thresholds on diabetes in a Chinese population and to assess their health economics value. Methods In this study, we constructed an event probability-based Microsimulation model to assess the health economics value of statin therapy. The model was based on the Prediction for atherosclerotic cardio-vascular disease (ASCVD) risk in China (China-PAR) and used data from a nationally representative survey and published meta-analysis of the Chinese middle-aged and elderly population as input. We evaluated four different strategies: a 7.5% 10-year risk threshold strategy, a guideline strategy, a 15% 10-year risk threshold strategy, and a 20% 10-year risk threshold strategy. Additionally, we calculated the incremental cost per quality-adjusted life year (QALY) obtained for each strategy to better understand the economics of the various strategies. Result The incremental cost per QALY for the 10% 10-year risk threshold strategy, compared to the untreated, was $52,218.75. The incremental cost per QALY for the guideline strategy, compared to the 7.5% 10-year risk threshold strategy, was $464,614.36. These results were robust in most sensitivity analyses. Conclusion The current 10-year ASCVD risk thresholds used in China’s dyslipidemia management guidelines are cost-effective in preventing ASCVD events and should be maintained with the current statin initiation thresholds. Relaxing the initiation threshold as willingness to pay increases would be more cost-effective. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Availability of data and materials The datasets supporting the conclusions are available from the corresponding author (Yu X, xhyu{at}jlu.edu.cn) on reasonable request. * AMI : Acute myocardial infarction ASCVD : Atherosclerotic cardiovascular disease CHD : Coronary heart disease CHARLS : China Health and Retirement Longitudinal Study China-PAR : Prediction for Atherosclerotic Cardiovascular Disease Risk in China ICER : Incremental cost-benefit ratio PSA : Probabilistic sensitivity analyses QALY : Quality-adjusted life year WTP : Willingness-to-pay