Evidence map›Paper›PMID 33749164›Full record

ArticleJournal of the International AIDS Society2021

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

David C Boettiger, Anthony T Newall, Andrew Phillips, Eran Bendavid, Matthew G Law, Lene Ryom, Peter Reiss, Amanda Mocroft, Fabrice Bonnet, Rainer Weber and 9 more

Open access · goldFull text read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.9field-weighted citation impact, top 14% 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

6 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 13 institutions in 9 countries.

David C BoettigerPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.ORCID 0000-0002-5951-4503
Anthony T NewallThe School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia.
Andrew PhillipsInstitute for Global Health, University College London, London, UK.ORCID 0000-0003-2384-4807
Eran BendavidCenter for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
Matthew G LawKirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Lene RyomRigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Peter ReissAmsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Amanda MocroftInstitute for Global Health, University College London, London, UK.
Fabrice BonnetUniversité Bordeaux, CHU de Bordeaux, France.
Rainer WeberUniversity Hospital Zurich, University of Zurich, Zurich, Switzerland.
Wafaa El-SadrICAP-Columbia University and Harlem Hospital, New York, NY, USA.ORCID 0000-0003-3735-9781
Antonella d'Arminio MonforteClinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
Stephane de WitSaint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Christian PradierDepartment of Public Health, Nice University Hospital, Nice, France.
Camilla I HatlebergRigshospitalet, University of Copenhagen, Copenhagen, Denmark.ORCID 0000-0002-4396-6281
Jens LundgrenRigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Caroline SabinInstitute for Global Health, University College London, London, UK.
James G KahnPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Dhruv S KaziSmith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
University College London · GBUniversity of Copenhagen · DKLee University · USUNSW Sydney · AUBeth Israel Deaconess Medical Center · USCentre Hospitalier Universitaire de Bordeaux · FRCentre Hospitalier Universitaire de Nice · FRHarlem Hospital Center · USOspedale San Paolo · ITStanford University · USStichting HIV Monitoring · NLUniversité Libre de Bruxelles · BEUniversity of Zurich · CH

Funding

COMMUNITY PROGRAMS FOR CLINICAL RESEARCH ON AIDSU01AI046362 · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · 2000 to 2005
$68.0M
TERRY BEIRN COMMUNITY PROGRAMS FOR CLINICAL RESEARCH ONU01AI042170 · UNIVERSITY OF MINNESOTA TWIN CITIES · 1997 to 2005
$21.4M
IeDEA Asia-Pacific Research CollaborationU01AI069907 · FOUNDATION FOR AIDS RESEARCH · 2025 to 2025
$2.5M
NIAID NIH HHS U01 AI042170NIAID NIH HHS U01 AI046362NIAID NIH HHS U01 AI069907
6 · The paper itself

Abstract

backgroundExpanding 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 to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States.

methodsWe developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years.

resultsPersons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal.

conclusionsPravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.

Indexed as

Anti-HIV AgentsAntiretroviral Therapy, Highly ActiveAtherosclerosisCardiovascular DiseasesCost-Benefit AnalysisHealth Care CostsHIV InfectionsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsPrimary PreventionQuality-Adjusted Life YearsUnited StatesAnti-HIV AgentsHydroxymethylglutaryl-CoA Reductase Inhibitorsantiretroviral therapycardiovascular diseasecost-effectivenessHIVstatinUnited States

Identifiers

PMID33749164
PMCPMC7982504
OpenAlexW3137747624

What Socratic holds

Textfull text, public
LicenceCC BY
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.