Cost-effectiveness of lipid lowering with statins and ezetimibe in chronic kidney disease

Iryna Schlackow, Seamus Kent, William Herrington, Jonathan Emberson, Richard Haynes, Christina Reith, Rory Collins, Martin J. Landray, Alastair Gray, Colin Baigent, Borislava Mihaylova, SHARP Collaborative Group, A. Cass

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Abstract

Statin-based treatments reduce cardiovascular disease (CVD) risk in patients with non-dialysis chronic kidney disease (CKD), but it is unclear which regimen is the most cost-effective. We used the Study of Heart and Renal Protection (SHARP) CKD-CVD policy model to evaluate the effect of statins and ezetimibe on quality-adjusted life years (QALYs) and health care costs in the United States (US) and the United Kingdom (UK). Net costs below $100,000/QALY (US) or £20,000/QALY (UK) were considered cost-effective. We investigated statin regimens with or without ezetimibe 10 mg. Treatment effects on cardiovascular risk were estimated per 1-mmol/L reduction in low-density lipoprotein (LDL) cholesterol as reported in the Cholesterol Treatment Trialists’ Collaboration meta-analysis, and reductions in LDL cholesterol were estimated for each statin/ezetimibe regimen. In the US, atorvastatin 40 mg ($0.103/day as of January 2019) increased life expectancy by 0.23 to 0.31 QALYs in non-dialysis patients with stages 3B to 5 CKD, at a net cost of $20,300 to $78,200/QALY. Adding ezetimibe 10 mg ($0.203/day) increased life expectancy by an additional 0.05 to 0.07 QALYs, at a net cost of $43,600 to $91,500/QALY. The cost-effectiveness findings and policy implications in the UK were similar. In summary, in patients with non-dialysis-dependent CKD, the evidence suggests that statin/ezetimibe combination therapy is a cost-effective treatment to reduce the risk of CVD.

Original languageEnglish
Pages (from-to)170-179
Number of pages10
JournalKidney International
Volume96
Issue number1
Early online date12 Mar 2019
DOIs
Publication statusPublished - Jul 2019

Bibliographical note

Copyright © 2019, International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Keywords

  • chronic kidney disease
  • cost-effectiveness
  • ezetimibe
  • health care costs
  • quality-adjusted life years
  • statin

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    Schlackow, I., Kent, S., Herrington, W., Emberson, J., Haynes, R., Reith, C., Collins, R., Landray, M. J., Gray, A., Baigent, C., Mihaylova, B., SHARP Collaborative Group, & Cass, A. (2019). Cost-effectiveness of lipid lowering with statins and ezetimibe in chronic kidney disease. Kidney International, 96(1), 170-179. https://doi.org/10.1016/j.kint.2019.01.028