Cost-Effectiveness of the Modified NHI Reimbursement Criteria for Cholesterol-lowering Therapy on the Prevention of Cardiovascular Diseases: using Statin as an example

• Main Authors: Ling-En Hsieh, 謝靈恩
• Other Authors: Ming-Chin Yang
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/netfur

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Background: In Taiwan, cardiovascular diseases (CVD) are the leading causes of death for over 10 years in succession, and it is a crucial health issue and additionally impose an heavy economic burden on health care systems, particularly among the older patients. Statin is commonly used in cholesterol-lowering therapy to prevent CVD. With the rapid growth of CVD prevalence, in 2013, Taiwan’s National Health Insurance (NHI) reimbursement criteria for cholesterol-lowering therapy was modified to expand the use of cholesterol-lowering medicine. The new policy would contribute to an increase in both the number of eligible patients and statin medicine expenditures considerably. Objective: This study aims to evaluate the benefits and the cost-effectiveness of statin therapy for the newly eligible patients over 65 years old with CVD or diabetes under the modified NHI reimbursement criteria for cholesterol-lowering therapy in 2013, and to provide the evidence-based information for future research and decision-makers in Taiwan. Methods: We designed a Markov model to evaluate the cost-effectiveness of statin therapy for a hypothetical 65-year-old cohort with LDL cholesterol levels of 100-130 mg/dL having a history of CVD (angina, MI, stroke) or type 2 diabetes in Taiwan. The model used a lifetime time horizon, Taiwan’s NHI healthcare payer perspective, and 3% discount rate for costs and health outcomes. Data sources for model parameters included Taiwan’s National Health Insurance Research Database (NHIRD), large clinical trials and meta-analyses for the statin treatment, and other published sources. Main outcomes were incremental costs per quality-adjusted life-year (QALY) gained. Results: In the base-case analysis, cost-effectiveness results for the lifetime statin therapy in patients with a history of angina, MI, stroke or diabetes was NT$ 91 739, NT$ 121 356, NT$ 131 694 and NT$ 227 938 per QALY gained, respectively. In the one-way sensitivity analysis, the disutility caused by daily medication use was found to have a moderate impact on the cost-effectiveness of statin treatment, particularly for diabetic patients. Cost-effectiveness results were sensitive to changes in time horizons modeled. In Monte Carlo probabilistic sensitivity analysis, there was always had a high likelihood of being highly cost-effective at the thresholds of NT$ 700 000. Conclusion: This economic evaluation from Taiwan’s NHI perspective demonstrates that under the modified NHI reimbursement criteria, statin therapy would be effective and highly cost-effective for prevention of CVD for the newly eligible patients over 65 years old with CVD or diabetes. Early intervention with statins has better effectiveness and cost-effectiveness results among CVD patients. Importantly, the time horizon of the models plays a significant role in the cost-effectiveness of statin treatment. This finding also raises the importance of early and continuing treatment for a longer duration to achieve the optimal benefit of the investment in statins.