Clinical Research
Atherosclerosis
The Cost-Effectiveness of C-Reactive Protein Testing and Rosuvastatin Treatment for Patients With Normal Cholesterol Levels

https://doi.org/10.1016/j.jacc.2010.07.059Get rights and content
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Objectives

We sought to evaluate the cost-effectiveness of applying the JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial results into clinical practice.

Background

The JUPITER trial found that rosuvastatin reduces vascular events in apparently healthy subjects with elevated high-sensitivity C-reactive protein (hs-CRP) but normal low-density lipoprotein (LDL) cholesterol levels. The implications of expanding treatment recommendations based on these results have not been evaluated.

Methods

We constructed a cost-effectiveness model of men ≥50 years and women ≥60 years with LDL cholesterol levels of <130 mg/dl and no known cardiovascular disease. We compared: 1) hs-CRP testing followed by rosuvastatin treatment for patients with hs-CRP levels ≥2.0 mg/l; and 2) usual care (i.e., no testing and no treatment). Estimates of treatment effectiveness were based on the JUPITER trial and were varied in sensitivity analyses.

Results

Among patients with LDL <130 mg/dl and hs-CRP levels ≥2.0 mg/l, rosuvastatin had an incremental cost-effectiveness of $25,198 per quality-adjusted life year (QALY) gained compared to usual care. If the effectiveness of rosuvastatin were 50% of that observed in JUPITER, the incremental cost-effectiveness ratio would increase to $50,871 per QALY. Implementing this strategy only in patients with a Framingham risk score ≥10% yielded an incremental cost-effectiveness of $14,205 per QALY. Among such intermediate-risk patients, a JUPITER-based strategy becomes cost-saving at a rosuvastatin price of <$0.86 per day.

Conclusions

Rosuvastatin treatment for JUPITER-eligible patients appears to be cost-effective, particularly among those with a Framingham risk score ≥10%.

Key Words

cost-effectiveness
hs-CRP
statin

Abbreviations and Acronyms

hs-CRP
high-sensitivity C-reactive protein
LDL
low-density lipoprotein
MI
myocardial infarction
QALY
quality-adjusted life year

Cited by (0)

This study was not funded by any external source, and no author receives any personal compensation from any pharmaceutical manufacturer. Dr. Glynn has received salary support for his work on the JUPITER trial through a research grant from AstraZeneca. The authors have no other potential conflicts of interest. The authors are employees of Brigham and Women's Hospital, an institution that 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.