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In 2008, BWH researchers made headlines around the world when they announced a breakthrough finding with the potential to change the way physicians assess patients’ risk of heart disease.
“The JUPITER trial addressed a very specific clinical scenario – does a particular statin, rosuvastatin, reduce the risk of a major cardiac event for patients with elevated levels of a protein, called high sensitivity C-reactive protein (hs-CRP),” said Niteesh Choudhry, MD, PhD, a researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH. “But what should we do with this information in the real world?”
Choudhry and his team set out to answer that question by researching the cost-effectiveness of the JUPITER findings. The trial found that when given to men and women with normal levels of cholesterol but increased levels of hs-CRP, the medication rosuvastatin reduced the risk of heart attack, stroke and cardiovascular disease by half. But, in order to be applied into actual practice, the costs of performing hs-CRP testing and providing rosuvastatin treatment need to be considered.
In studying the cost-effectiveness of JUPITER, Choudhry and his team made a surprising discovery.
“What we found is that not only is the test and treatment approach cost-effective, but it actually has the potential for cost-savings for patients with an intermediate risk for a cardiac event,” said Choudhry, the lead author of the study, which was published in the Feb. 15 issue of the Journal of the American College of Cardiology.
To evaluate the balance between the potential benefits and health care costs, researchers used a computer simulation model to evaluate a cohort of patients similar to those evaluated in the JUPITER trial. The model used data related to cost of the screening test, treatment with rosuvastatin if indicated and the treatment of cardiovascular events.
Using this information, researchers weighed the benefits of a test and treat approach against the cost of providing this care and found the approach to be cost-effective at $25,198 per quality adjusted life year when compared to the usual care (no test and no treatment). A quality-adjusted life year is a metric that is calculated with consideration for not only length of life, but also for how well patients live. In the U.S., health care interventions are considered cost-effective at rates lower than $50,000 to $100,000 per quality-adjusted life year.
“In these times of constrained health care resources, it’s important that every new potentially costly intervention be subjected to rigorous analysis of how cost-effective it is, compared to other approaches,” said Jerry Avorn, MD, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics and senior author of the study. “Our study found that this treatment strategy is actually a ‘good deal’ both economically and clinically, and could even save money if the price of the drug were closer to that of other statins.”