Cost-effectiveness of statins for primary prevention in newly diagnosed type 2 diabetes patients:An illustration for The Netherlands

Background: Patients with type 2 diabetes have an increased risk of cardiovascular events, which can be reduced by statin treatment. Objectives: The aim of this study is to determine if statin treatment for primary prevention started at the time of type 2 diabetes diagnosis is cost-effective, taking non-adherence and different age groups into account. Methods: A cost-effectiveness analysis has been performed using a Markov model with a time horizon of 10 years. The 10-years cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the GIANTT database (Groningen Initiative to Analyse Type 2 Diabetes Treatment) using the UKPDS risk engine. Statin adherence of a Dutch type 2 diabetes population was measured as pill days covered (PDC) in the IADB pharmacy research database. PDC of ≥ 80% and ≤ 20% were associated with full and no efficacy of the treatment. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the healthcare payers perspective, also stratified for cardiovascular risk and age. A probabilistic sensitivity analysis was performed. Results: Characteristics of 4,683 primary prevention type 2 diabetes patients were inserted into the UKPDS risk engine. The mean 10-years risk of the population was 23% for coronary heart disease (CHD), 14% for fatal CHD, 10% for stroke and 2% for fatal stroke. PDC in the type 2 diabetes population was 81%, 77% and 75% in years one, two and three, respectively. In general, statin treatment was highly cost-effective at around €2,500 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-years cardiovascular risk showed large differences in cost-effectiveness ranging from more than €800,000 per QALY to being cost saving. Conclusions: Statin treatment for primary prevention in patients newly diagnosed with type 2 diabetes is costeffective. Due to large differences in cost-effectiveness according to different risk groups, the efficiency of the treatment could be increased by focusing on patients with higher cardiovascular risk and higher ages