Background: HMG-CoA reductase inhibitors (statins) are potentially excellent candidate agents for patients with rheumatoid arthritis (RA). They reduce both cardiovascular risks and RA disease activity.
Objective: To evaluate the potential long-term effects of statin therapy among patients with RA, and to determine their associated cost effectiveness by incorporating both the cardiovascular and the anti-rheumatic benefits.
Methods: A Markov decision-analytic model was developed to simulate cardiovascular and RA disease profiles over time. The impact of statin therapy was estimated by adjusting the risk of coronary heart disease (CHD) events and changes in the RA Disease Activity Score (DAS28), based on the results of a randomized trial. The benefits (QALYs) and costs (in year 2005 values) were evaluated from a US payer perspective. A full uncertainty analysis, including a value-of-information (VOI) analysis, was undertaken to evaluate the importance of individual parameters.
Results: Using a 10-year time horizon, the additional cost and QALYs of statin therapy were estimated to be $US4690 and 0.44 QALYs, respectively, resulting in an incremental cost-effectiveness ratio (ICER) of $US10 650 per QALY (95% CI 1525, 156 565). The QALY gain associated with statin therapy depended more on the anti-rheumatic effects of statin therapy than on its cardiovascular prevention effect. The VOI analysis found the long-term benefit of statin therapy (i.e. ≥12 months) and the consequent impact on quality of life to be the most uncertain and, therefore, influential parameters.
Conclusion: Our analysis indicates that the dual anti-inflammatory/cardiovascular benefits of statins could make this therapy highly cost effective in RA. However, uncertainties remain in the available data, warranting further research on refining the precise RA disease-activity benefits and health-utility changes associated with statin therapy, at least over a 12-month period.
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No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.
Nick Bansback and Aslam Anis were involved in the study design, analysis and writing of the article. Roberta Ara and Sue Ward were involved in the CHD model design and writing of the article. Hyon Choi derived the study question, gave advice to the RA model and helped write the article. The authors thank Daphne Guh and Huiying Sun for their assistance in the development of the code and James Rankin for his editorial assistance.
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