06:56am Friday 15 December 2017

New Analysis Finds CRP Testing Followed by Rosuvastatin Therapy Cost-Effective

Choudhry, MD, PhD summarizes the findings of his cost-effective analysis.

They found that not only does the JUPITER-based test and treat approach appear cost-effective; it also has the potential to be cost-saving.  These results are published in the February 15, 2011 issue of the Journal of the American College of Cardiology.

“We found that when compared to usual care of not testing and not treating, hs-CRP testing followed by rosuvastatin treatment, when indicated, appears cost-effective particularly for patients with an intermediate risk for a cardiac event,” said Niteesh Choudhry, MD, PhD, lead author of the study and a researcher in the Division of Pharmacoepidemiology at BWH.  “Additionally, this approach has the potential to become cost-saving if the cost of rosuvastatin, a medication currently only available under the brand name, is lowered.”  

To evaluate the balance between the potential benefits and health care costs, researchers used a computer simulation model to evaluate a cohort of patients similar to those evaluated in the JUPITER trial.  The model incorporated data related to cost of the screening test, treatment with rosuvastatin if indicated and the treatment of cardiovascular events.  The effectiveness of rosuvastatin was based on data from JUPITER.

Using this information, researchers were able to weigh the benefits of a test and treat approach against the cost of providing this care and found the approach to be cost-effective at $25,198 per quality adjusted life year (QALY) when compared to the usual care (no test and no treatment).  In the United States, health care interventions are considered cost-effectiveness at rates lower than $50,000 – $100,000 per QALY.  A QALY is a metric that is calculated with consideration for not only length of life, but also for how well patients live during that time they are alive.

Additionally researchers report:

 

  • When this strategy is modeled in patients with an intermediate risk for vascular events, defined as a Framingham risk score of more than 10 percent, the screen and treat approach was cost-effective at $14,205 per QALY. 
  • The analysis was performed using $3.63 per day for the cost of rosuvastatin as quoted by a major online pharmacy.  However, among these intermediate-risk patients, the test and treat strategy becomes cost-saving at a rosuvastatin price of $0.86 per day, 
  • When assuming the effectiveness of rosuvastatin at 50 percent less than observed in JUPITER, the test and treat approach becomes cost-saving for intermediate risk patients at a cost of $0.11 per day, which is equivalent to what pravastatin and lovastatin, which are available as generics, currently cost at many major pharmacies.

“In these times of constrained health care resources, it’s important that every new potentially costly intervention be subjected to rigorous analysis of how cost-effective it is, compared to other approaches.  Our study found that this treatment strategy is actually a ‘good deal’ both economically and clinically, and could even save money if the price of the drug were closer to that of other statins. This could well occur before too long,” added Jerome Avorn, MD, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH and senior author of the study.

Disclosure: The authors are employees of BWH, which holds patents that relate to the use of high-sensitivity C-reactive protein in the evaluation of patients’ risk of cardiovascular disease, but the authors do not benefit from these patents.


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