Evidence mapPaperPMID 23500327Full record

SynthesisJournal of the American College of Cardiology2013

Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease.

Kevin F Erickson, Sohan Japa, Douglas K Owens, Glenn M Chertow, Alan M Garber, Jeremy D Goldhaber-Fiebert

Abstract readMeta-Analysis
In one paragraph

Synthesis in Journal of the American College of Cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 2 pooled it
7.3field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 83 citations in OpenAlex.

  1. Pooled it
  2. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis.Clinical journal of the American Society of Nephrology : CJASN · 2015 · on this map
    Pooled it
  3. Trial
  4. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).American journal of kidney diseases : the official journal of the National Kidney Foundation · 2016 · on this map
    Trial
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Kevin F EricksonDivision of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA. kevine1@stanford.edu
Sohan Japa
Douglas K Owens
Glenn M Chertow
Alan M Garber
Jeremy D Goldhaber-Fiebert
Stanford University · USHarvard University · USPalo Alto University · USVA Palo Alto Health Care System · US

Funding

AHRQ HHS F32 HS019178NIA NIH HHS AG037593NIA NIH HHS K01 AG037593NIDDK NIH HHS DK085446NIDDK NIH HHS K24 DK085446NIDDK NIH HHS L30 DK096657
6 · The paper itself

Abstract

objectivesThe authors sought to evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD).

backgroundPatients with CKD have an elevated risk of MI and stroke. Although HMG Co-A reductase inhibitors (“statins”) may prevent cardiovascular events in patients with non–dialysis-requiring CKD, adverse drug effects and competing risks could materially influence net effects and clinical decision-making.

methodsWe developed a decision-analytic model of CKD and cardiovascular disease (CVD) to determine the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted quality-adjusted life years (QALYs) and lifetime costs (2010 USD), and incremental cost-effectiveness ratios.

resultsFor 65-year-old men with moderate hypertension and mild-to-moderate CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and increased costs by $1,800 ($18,000 per QALY gained). For patients with lower baseline cardiovascular risks, health and economic benefits were smaller; for 65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and drug costs. Statins are less cost-effective when obtained at average retail prices, particularly in patients at lower CVD risk.

conclusionsAlthough statins reduce absolute CVD risk in patients with CKD, the increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.

Indexed as

RhabdomyolysisAgedCost-Benefit AnalysisDecision Support TechniquesDisease ProgressionDrug CostsFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypertensionKidney Failure, ChronicMaleMarkov ChainsMyocardial InfarctionPravastatinPrimary PreventionHydroxymethylglutaryl-CoA Reductase InhibitorsPravastatin

Identifiers

PMID23500327
PMCPMC3688058
OpenAlexW2040545278

What Socratic holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.