The Cost-Effectiveness of C-Reactive Protein Testing and Rosuvastatin Treatment for Patients With Normal Cholesterol Levels

Study Questions:

What is the cost-effectiveness of applying the JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial results into clinical practice?

Methods:

The authors developed a cost-effectiveness model of men ≥50 years and women ≥60 years with low-density lipoprotein (LDL) cholesterol levels of <130 mg/dl and no known cardiovascular disease. Comparisons were: 1) high-sensitivity C-reactive protein (hs-CRP) testing followed by rosuvastatin treatment for patients with hs-CRP levels ≥2.0 mg/L, and 2) usual care (i.e., no testing and no treatment). Estimates of treatment effectiveness were based on the JUPITER trial and were varied in sensitivity analyses.

Results:

Among patients with LDL <130 mg/dl and hs-CRP levels ≥2.0 mg/L, rosuvastatin had an incremental cost-effectiveness of $25,198 per quality-adjusted life-year (QALY) gained compared to usual care. If the effectiveness of rosuvastatin were 50% of that observed in JUPITER, the incremental cost-effectiveness ratio would increase to $50,871 per QALY. Implementing this strategy only in patients with a Framingham risk score ≥10% yielded an incremental cost-effectiveness of $14,205 per QALY. Among such intermediate-risk patients, a JUPITER-based strategy becomes cost-saving at a rosuvastatin price of <$0.86 per day.

Conclusions:

Rosuvastatin treatment for JUPITER-eligible patients appears to be cost-effective, particularly among those with a Framingham risk score ≥10%.

Perspective:

Even the analysis that includes assumptions biased against the JUPITER results (e.g., no incremental benefit after 19 months and risk reduction at the lower end of 95% confidence interval), a strategy of rosuvastatin 20 mg in men ≥50 years and women ≥60 years with an hs-CRP ≥2 mg/dl and LDL cholesterol <130 mg/dl appears to be within cost-effective standards developed in the United States ($50K to $100K per QALY). Interestingly, the authors determined that if one of the generically available statins were only 75% as effective as rosuvastatin, its use in an hs-CRP test-and-treat strategy in patients with a Framingham risk score of ≥10% would be cost-saving at a daily drug cost of $0.49 per day.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins, Statins

Keywords: Fluorobenzenes, Cholesterol, C-Reactive Protein, Biological Markers, Risk Reduction Behavior, Cardiovascular Diseases, Pyrimidines, United States, Sulfonamides, Treatment Outcome


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