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Statin Therapy in Rheumatoid Arthritis

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  • Nick Bansback
  • Roberta Ara
  • Sue Ward
  • Aslam Anis
  • Hyon Choi

Abstract

Background: HMG-CoA reductase inhibitors (statins) are potentially excellent candidate agents for patients with rheumatoid arthritis (RA). They reduce both cardiovascular risks and RA disease activity. Objective: To evaluate the potential long-term effects of statin therapy among patients with RA, and to determine their associated cost effectiveness by incorporating both the cardiovascular and the anti-rheumatic benefits. Methods: A Markov decision-analytic model was developed to simulate cardiovascular and RA disease profiles over time. The impact of statin therapy was estimated by adjusting the risk of coronary heart disease (CHD) events and changes in the RA Disease Activity Score (DAS28), based on the results of a randomized trial. The benefits (QALYs) and costs (in year 2005 values) were evaluated from a US payer perspective. A full uncertainty analysis, including a value-of-information (VOI) analysis, was undertaken to evaluate the importance of individual parameters. Results: Using a 10-year time horizon, the additional cost and QALYs of statin therapy were estimated to be $US4690 and 0.44 QALYs, respectively, resulting in an incremental cost-effectiveness ratio (ICER) of $US10 650 per QALY (95% CI 1525, 156 565). The QALY gain associated with statin therapy depended more on the anti-rheumatic effects of statin therapy than on its cardiovascular prevention effect. The VOI analysis found the long-term benefit of statin therapy (i.e. ≥12 months) and the consequent impact on quality of life to be the most uncertain and, therefore, influential parameters. Conclusion: Our analysis indicates that the dual anti-inflammatory/cardiovascular benefits of statins could make this therapy highly cost effective in RA. However, uncertainties remain in the available data, warranting further research on refining the precise RA disease-activity benefits and health-utility changes associated with statin therapy, at least over a 12-month period. Copyright Adis Data Information BV 2009

Suggested Citation

  • Nick Bansback & Roberta Ara & Sue Ward & Aslam Anis & Hyon Choi, 2009. "Statin Therapy in Rheumatoid Arthritis," PharmacoEconomics, Springer, vol. 27(1), pages 25-37, January.
    • Handle: RePEc:spr:pharme:v:27:y:2009:i:1:p:25-37
    DOI: 10.2165/00019053-200927010-00004
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    References listed on IDEAS

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    1. Grieve, Richard & Hutton, John & Green, Colin, 2003. "Selecting methods for the prediction of future events in cost-effectiveness models: a decision-framework and example from the cardiovascular field," Health Policy, Elsevier, vol. 64(3), pages 311-324, June.
    2. Sawsan Youssef & Olaf Stüve & Juan C. Patarroyo & Pedro J. Ruiz & Jennifer L. Radosevich & Eun Mi Hur & Manuel Bravo & Dennis J. Mitchell & Raymond A. Sobel & Lawrence Steinman & Scott S. Zamvil, 2002. "The HMG-CoA reductase inhibitor, atorvastatin, promotes a Th2 bias and reverses paralysis in central nervous system autoimmune disease," Nature, Nature, vol. 420(6911), pages 78-84, November.
    3. Andrew H. Briggs & A. E. Ades & Martin J. Price, 2003. "Probabilistic Sensitivity Analysis for Decision Trees with Multiple Branches: Use of the Dirichlet Distribution in a Bayesian Framework," Medical Decision Making, , vol. 23(4), pages 341-350, July.
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    1. Ara, Roberta & Brazier, John, 2009. "Populating an economic model with health state utility values: moving towards better practice," MPRA Paper 29896, University Library of Munich, Germany.

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