Abstract:
OBJECTIVES:High-sensitivity C-reactive protein (hs-CRP) has been explored for use in predicting cardiovascular risk. The recent Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study found that statin therapy reduced cardiovascular events in those with low-density lipoprotein (LDL) cholesterol levels below current treatment thresholds (≤130 mg/dL, 3.4 = mmol/L), but with elevated hs-CRP levels (≥2.0 mg/L). This study examines the cost-effectiveness of statin treatment for individuals with elevated hs-CRP but normal LDL cholesterol. METHODS:A Markov decision-analytic model was conducted from the U.S. societal perspective. Data from JUPITER were used to estimate rates of myocardial infarction, angina and stroke. Statin costs were based on generic simvastatin 80 mg, equipotent to the rosuvastatin 20 mg dose used in JUPITER. Primary prevention was the focus and secondary prevention was not modeled explicitly. Quality-adjusted life-years (QALYs) were calculated using nationally representative preference-based utility weights. One-way sensitivity analyses and multivariate probabilistic sensitivity analysis were used to explore uncertainty in model parameters as well as estimate the likelihood of cost-effectiveness when all event rates, costs and utilities were drawn randomly from distributions reflecting uncertainty. RESULTS:Statin therapy cost $10,889/QALY for vascular event prevention in this population. Results were sensitive to the cost of statin treatment. Based on 10,000 simulations, statin therapy was cost-effective in 99.5% of simulations, using a willingness-to-pay threshold of $20,000/QALY, and 100% of simulations using a threshold of $50,000/QALY. CONCLUSIONS:Treatment with statins in patients with elevated hs-CRP but normal cholesterol appears to be cost-effective. Limitations of this study include the assumption that an equipotent dose of simvastatin resulted in the same risk reduction as rosuvastatin. Further, post-event states simulated the average experience of a patient. Continued statin use, subsequent events and/or heart failure were not explicitly modeled.
journal_name
Curr Med Res Opinjournal_title
Current medical research and opinionauthors
Slejko JF,Page RL 2nd,Sullivan PWdoi
10.1185/03007995.2010.516994subject
Has Abstractpub_date
2010-10-01 00:00:00pages
2485-97issue
10eissn
0300-7995issn
1473-4877journal_volume
26pub_type
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1185/03007997809111903
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abstract:BACKGROUND:Most patients with hypertension require more than one drug to attain recommended blood pressure (BP) targets. Initiating therapy with two agents is recommended for patients at high risk of a cardiovascular event or with a BP > 20/10 mmHg above goal. Combination therapy is effective when comprised of agents w...
journal_title:Current medical research and opinion
pub_type: 杂志文章,评审
doi:10.1185/03007990802597456
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1185/03007999609115224
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abstract::Hypertension is another predictor of erectile dysfunction (ED). This is further evidence supporting a link between the pathogenesis of atherosclerotic disease and ED. In one study (TOMHS) involving hypertensive patients, the incidence of ED was 14.4%. The drugs used to treat hypertension may cause ED. However, there i...
journal_title:Current medical research and opinion
pub_type: 杂志文章,评审
doi:10.1185/0300799009117037
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journal_title:Current medical research and opinion
pub_type: 杂志文章
doi:10.1185/03007997609109292
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journal_title:Current medical research and opinion
pub_type: 杂志文章,评审
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journal_title:Current medical research and opinion
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journal_title:Current medical research and opinion
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journal_title:Current medical research and opinion
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journal_title:Current medical research and opinion
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1185/030079906x167697
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journal_title:Current medical research and opinion
pub_type: 杂志文章,评审
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journal_title:Current medical research and opinion
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doi:10.1185/03007995.2015.1058770
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journal_title:Current medical research and opinion
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doi:10.1185/030079902125000444
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章
doi:10.1185/03007997709108988
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journal_title:Current medical research and opinion
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journal_title:Current medical research and opinion
pub_type: 临床试验,杂志文章
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journal_title:Current medical research and opinion
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pub_type: 杂志文章,meta分析,评审
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journal_title:Current medical research and opinion
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journal_title:Current medical research and opinion
pub_type: 杂志文章,meta分析
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journal_title:Current medical research and opinion
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