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Cost-Effectiveness of Primary Prevention with Statin Treatment for Chinese Patients with Type 2 Diabetes

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Abstract

Introduction

Statins can reduce the risk of cardiovascular events in patients with diabetes. The objective of this analysis was to evaluate whether primary prevention with statin treatment is cost-effective for newly diagnosed type 2 diabetes mellitus (T2DM) patients in the Chinese context.

Methods

An economic analysis of primary prevention with statin treatment was conducted using the Chinese Outcomes Model for T2DM with a time horizon of a lifetime, which was developed and validated based on the Chinese population. Clinical costs and utility inputs were gathered from published sources. Lifetime discounted quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER) were measured. The uncertainty was evaluated by one-way and probabilistic sensitivity analyses.

Results

Statin treatment with atorvastatin 10 mg could add 0.08 QALYs with an additional $1676 compared with that of no statin management (control strategy) over a lifetime horizon, which led to an ICER of $21,924 per QALY gained. At a willingness-to-pay threshold of $27,351 per QALY gained, there was an approximately 80% probability of statin treatment being cost-effective compared with the control strategy. The model outcomes were most sensitive to the length of the expected life and age at the T2DM diagnosis.

Conclusions

Statin treatment with atorvastatin is most likely cost-effective for primary prevention in Chinese patients newly diagnosed with type 2 diabetes.

Funding

Partially funded by Pfizer Inc.

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References

  1. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260–344.

    Article  Google Scholar 

  2. Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310:948–59.

    Article  CAS  Google Scholar 

  3. Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017;317:2515–23.

    Article  Google Scholar 

  4. Wang H, Lin X, Zhang Z, Wang Q, Chen J-M, Liu J, et al. The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital. Asia Pac J Public Health. 2015;27:49S–54S.

    Article  Google Scholar 

  5. Chan JCN, Zhang Y, Ning G. Diabetes in China: a societal solution for a personal challenge. Lancet Diabetes Endocrinol. 2014;2:969–79.

    Article  Google Scholar 

  6. Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SRK, Gobin R, Kaptoge S, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.

    Article  Google Scholar 

  7. Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380:581–90.

    Article  Google Scholar 

  8. de Vries FM, Denig P, Pouwels KB, Postma MJ, Hak E. Primary prevention of major cardiovascular and cerebrovascular events with statins in diabetic patients: a meta-analysis. Drugs. 2012;72:2365–73.

    Article  Google Scholar 

  9. Chinese Diabetes Society. 2013 China guideline for prevention and treatment of type 2 diabetes. Chin J Endocrinol Metab. 2014;30:893–942.

    Google Scholar 

  10. Raikou M, McGuire A, Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, et al. Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS). Diabetologia. 2007;50:733–40.

    Article  CAS  Google Scholar 

  11. Annemans L, Marbaix S, Webb K, Van Gaal L, Scheen A. Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population. Clin Drug Investig. 2010;30:133–42.

    Article  CAS  Google Scholar 

  12. Lafuma A, Colin X, Solesse A. Cost-effectiveness of atorvastatin in the prevention of cardiovascular events in diabetic patients: a French adaptation of CARDS. Arch Cardiovasc Dis. 2008;101:327–32.

    Article  Google Scholar 

  13. de Vries FM, Denig P, Visser ST, Hak E, Postma MJ. Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands. Value Health. 2014;17:223–30.

    Article  Google Scholar 

  14. Wu B, Ma J, Zhang S, Zhou L, Wu H. Development and validation of a Health Policy Model of Type 2 diabetes in Chinese setting. J Comp Eff Res. 2018. https://doi.org/10.2217/cer-2018-0001.

  15. Basu S, Sussman JB, Berkowitz SA, Hayward RA, Yudkin JS. Development and validation of Risk Equations for Complications Of type 2 Diabetes (RECODe) using individual participant data from randomised trials. Lancet Diabetes Endocrinol. 2017;5:788–98.

    Article  Google Scholar 

  16. Charokopou M, Sabater FJ, Townsend R, Roudaut M, McEwan P, Verheggen BG. Methods applied in cost-effectiveness models for treatment strategies in type 2 diabetes mellitus and their use in Health Technology Assessments: a systematic review of the literature from 2008 to 2013. Curr Med Res Opin. 2016;32:207–18.

    Article  CAS  Google Scholar 

  17. Wang X, Wang Z-F, Xie Y-M, Zhang W, Liao X, Chang Y-P, et al. Guideline for postmarketing Chinese medicine pharmacoeconomic evaluation. Chin J Integr Med. 2015;21:473–80.

    Article  CAS  Google Scholar 

  18. Ji L, Hu D, Pan C, Weng J, Huo Y, Ma C, et al. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients. Am J Med. 2013;126(925):e11–22.

    Google Scholar 

  19. Karlson BW, Barter PJ, Palmer MK, Lundman P, Nicholls SJ. Comparison of the effects of different statins and doses on lipid levels in patients with diabetes: results from VOYAGER. Nutr Metab Cardiovasc Dis. 2012;22:697–703.

    Article  CAS  Google Scholar 

  20. Tan NC, Koh KH, Goh CC, Koh YLE, Goh SCP. Asian patients with dyslipidemia in an urban population: effect of ethnicity on their LDL-cholesterol treatment goals. J Clin Lipidol. 2016;10:410–9.

    Article  Google Scholar 

  21. The Task Force of Lipid Metabolism. Expert consensus on prevention and treatment for type 2 diabetes mellitus complicated with dyslipidemia in China (2017). Chin J Endocrinol Metab. 2017;33:925–36.

    Google Scholar 

  22. Yang W, Zhao W, Xiao J, Li R, Zhang P, Kissimova-Skarbek K, et al. Medical care and payment for diabetes in China: enormous threat and great opportunity. PLoS ONE. 2012;7:e39513.

    Article  CAS  Google Scholar 

  23. Li T, Liu M, Ben H, Xu Z, Zhong H, Wu B. Clopidogrel versus aspirin in patients with recent ischemic stroke and established peripheral artery disease: an economic evaluation in a Chinese setting. Clin Drug Investig. 2015;35:365–74.

    Article  CAS  Google Scholar 

  24. Wu B, Wan X, Ma J. Cost-effectiveness of prevention and management of diabetic foot ulcer and amputation in a health resource-limited setting. J Diabetes. 2017;10(4):320–27.

    Article  Google Scholar 

  25. Shao H, Zhai S, Zou D, Mir MU, Zawadzki NK, Shi Q, et al. Cost-effectiveness analysis of dapagliflozin versus glimepiride as monotherapy in a Chinese population with type 2 diabetes mellitus. Curr Med Res Opin. 2017;33:359–69.

    Article  CAS  Google Scholar 

  26. Gu S, Mu Y, Zhai S, Zeng Y, Zhen X, Dong H. Cost-effectiveness of dapagliflozin versus acarbose as a monotherapy in type 2 diabetes in China. PLoS ONE. 2016;11:e0165629.

    Article  Google Scholar 

  27. Wu B, Zhang S, Lin H, Mou S. Prevention of renal failure in Chinese patients with newly diagnosed type 2 diabetes: a cost-effectiveness analysis. J Diabetes Investig. 2018;9:152–61.

    Article  CAS  Google Scholar 

  28. Pan C-W, Sun H-P, Zhou H-J, Ma Q, Xu Y, Luo N, et al. Valuing health-related quality of life in type 2 diabetes patients in China. Med Decis Mak. 2016;36:234–41.

    Article  Google Scholar 

  29. Craig BA, Black MA. Incremental cost-effectiveness ratio and incremental net-health benefit: two sides of the same coin. Expert Rev Pharmacoecon Outcomes Res. 2001;1:37–46.

    Article  CAS  Google Scholar 

  30. Bragg F, Holmes MV, Iona A, Guo Y, Du H, Chen Y, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China. JAMA. 2017;317:280–9.

    Article  Google Scholar 

  31. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HAW, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364:685–96.

    Article  CAS  Google Scholar 

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Acknowledgements

Funding

This work was sponsored by unrestricted grants from the National Natural Science Foundation of China (no. 71373160), Shanghai Municipal Health Commission (nos. 15GWZK0901, 2016ZB0304, and 2016-40044-002), and Pfizer Inc. The study sponsors had no influence on the study design, data collection, or writing of the manuscript. The study sponsors funded the journal’s article processing charges. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. We wish to thank the two anonymous reviewers for their constructive review and many suggestions that have helped improve the final version of the paper considerably. All data generated or analyzed during this study are included in this published article.

Disclosures

Bin Wu has received an unrestricted grant from Pfizer Inc. Te Li, Xu Wan, and Jin Ma have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Pharmacy, Fuwai Yunnan Cardiovascular Hospital, Affiliated with the Kunming Medical University, Kunming, China

    Te Li

  2. Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China

    Xu Wan & Bin Wu

  3. Department of Endocrinology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

    Jin Ma

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  1. Te Li
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  2. Xu Wan
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Correspondence to Bin Wu.

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Li, T., Wan, X., Ma, J. et al. Cost-Effectiveness of Primary Prevention with Statin Treatment for Chinese Patients with Type 2 Diabetes. Adv Ther 35, 2214–2223 (2018). https://doi.org/10.1007/s12325-018-0823-9

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