Cost?effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States

Background Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due their lack substantial interaction antiretroviral therapy. We aimed evaluate cost-effectiveness pravastatin for primary prevention among PLHIV United States. Methods developed a microsimulation model that randomly selected (with replacement) individuals from Data-collection on Adverse Effects Anti-HIV Drugs study follow-up between 2013 2016. Our population was aged 40 75 years, stable therapy, not currently using lipid-lowering Direct medical costs quality-adjusted life-years (QALYs) were assigned annual cycles discounted at 3% per year. assumed willingness-to-pay threshold $100,000/QALY gained. The interventions assessed as follows: (1) treating no one statins; (2) everyone generic mg/day (drug cost $236/year) (3) branded 4 $2,828/year). simulated each individual’s probability experiencing over 20 years. Results Persons receiving accrued 0.024 additional QALYs compared those statin, an incremental $1338, giving ratio $56,000/QALY Individuals accumulated 0.013 pravastatin, $18,251, $1,444,000/QALY These findings most sensitive pill associated daily administration, costs, efficacy baseline risk. In probabilistic sensitivity analysis, optimal 5.2% simulations, 94.8% simulations never optimal. Conclusions projected be cost-effective statin. With price reduction, pravastatin. bode well expanded statins To gain greater confidence our conclusions it is important generate strong, HIV-specific estimates quality-of-life taking pill.