Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis
Abstract Background Current guidelines for atherosclerotic cardiovascular disease (ASCVD) primary prevention mostly recommend risk scores that predict risk of non-fatal myocardial infarction, fatal ischemic heart disease (IHD), and fatal or non-fatal ischemic stroke (hard outcomes), ignoring the bur...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04222-8 |
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| author | Zhijia Sun Haijun Zhang Yinqi Ding Canqing Yu Dianjianyi Sun Yuanjie Pang Pei Pei Ling Yang Yiping Chen Huaidong Du Dan Huang Xiaoming Yang Maxim Barnard Robert Clarke Junshi Chen Zhengming Chen Liming Li Jun Lv on behalf of the China Kadoorie Biobank Collaborative Group |
| author_facet | Zhijia Sun Haijun Zhang Yinqi Ding Canqing Yu Dianjianyi Sun Yuanjie Pang Pei Pei Ling Yang Yiping Chen Huaidong Du Dan Huang Xiaoming Yang Maxim Barnard Robert Clarke Junshi Chen Zhengming Chen Liming Li Jun Lv on behalf of the China Kadoorie Biobank Collaborative Group |
| author_sort | Zhijia Sun |
| collection | DOAJ |
| description | Abstract Background Current guidelines for atherosclerotic cardiovascular disease (ASCVD) primary prevention mostly recommend risk scores that predict risk of non-fatal myocardial infarction, fatal ischemic heart disease (IHD), and fatal or non-fatal ischemic stroke (hard outcomes), ignoring the burden from other non-fatal IHD outcomes. We explored the optimal risk thresholds for statin initiation using non-laboratory-based soft and hard ASCVD outcome models and compared the cost-utility of such models in the Chinese population. Methods We constructed Markov cohort models to estimate the incidence of ASCVD events, costs, and quality-adjusted life years (QALYs) over a lifetime from a social perspective. The simulation cohort was constructed using data from the China Kadoorie Biobank (CKB). Input data included cost, utility, statin efficacy, and other parameters were derived from published literature. We used CKB-ASCVD models to predict 10-year risk and different risk thresholds to guide statin initiation. The incremental cost-effectiveness ratio (ICER) was estimated as cost per QALY gained. Sensitivity analyses were performed to explore the uncertainty in the models. Results The optimal risk threshold was 18% for the soft ASCVD model and 10% for the hard ASCVD model, with ICERs of $7013.48/QALY and $6540.71/QALY, respectively. The optimal thresholds were robust in stratified analyses by region and sex, and one-way sensitivity analyses over a wide range of input parameters. Probabilistic sensitivity analyses showed that these optimal thresholds had around 70% chance of being cost-effective. When analyzed by age group, above optimal thresholds were cost-effective in adults aged 30–59 years but not in those aged 60–75 years. The threshold strategies based on soft ASCVD model were mostly cost-saving compared with those based on hard models to treat the same proportions of the population. Conclusions The risk threshold of 18% for soft ASCVD model and 10% for hard ASCVD model have acceptable cost-utility profiles in the Chinese population. The soft ASCVD model is more cost-effective than the hard model and should be used as a screening tool for ASCVD primary prevention. |
| format | Article |
| id | doaj-art-232129b7d97b40beae0b2fc8e453400a |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-232129b7d97b40beae0b2fc8e453400a2025-08-20T04:01:34ZengBMCBMC Medicine1741-70152025-07-0123111410.1186/s12916-025-04222-8Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysisZhijia Sun0Haijun Zhang1Yinqi Ding2Canqing Yu3Dianjianyi Sun4Yuanjie Pang5Pei Pei6Ling Yang7Yiping Chen8Huaidong Du9Dan Huang10Xiaoming Yang11Maxim Barnard12Robert Clarke13Junshi Chen14Zhengming Chen15Liming Li16Jun Lv17on behalf of the China Kadoorie Biobank Collaborative GroupDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityDepartment of Health Policy and Management, School of Public Health, Peking UniversityDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityCenter for Public Health and Epidemic Preparedness & Response, Peking UniversityClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordRecord Department, Pengzhou Traditional Chinese Medical HospitalClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordChina National Center for Food Safety Risk AssessmentClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of OxfordDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityDepartment of Epidemiology & Biostatistics, School of Public Health, Peking UniversityAbstract Background Current guidelines for atherosclerotic cardiovascular disease (ASCVD) primary prevention mostly recommend risk scores that predict risk of non-fatal myocardial infarction, fatal ischemic heart disease (IHD), and fatal or non-fatal ischemic stroke (hard outcomes), ignoring the burden from other non-fatal IHD outcomes. We explored the optimal risk thresholds for statin initiation using non-laboratory-based soft and hard ASCVD outcome models and compared the cost-utility of such models in the Chinese population. Methods We constructed Markov cohort models to estimate the incidence of ASCVD events, costs, and quality-adjusted life years (QALYs) over a lifetime from a social perspective. The simulation cohort was constructed using data from the China Kadoorie Biobank (CKB). Input data included cost, utility, statin efficacy, and other parameters were derived from published literature. We used CKB-ASCVD models to predict 10-year risk and different risk thresholds to guide statin initiation. The incremental cost-effectiveness ratio (ICER) was estimated as cost per QALY gained. Sensitivity analyses were performed to explore the uncertainty in the models. Results The optimal risk threshold was 18% for the soft ASCVD model and 10% for the hard ASCVD model, with ICERs of $7013.48/QALY and $6540.71/QALY, respectively. The optimal thresholds were robust in stratified analyses by region and sex, and one-way sensitivity analyses over a wide range of input parameters. Probabilistic sensitivity analyses showed that these optimal thresholds had around 70% chance of being cost-effective. When analyzed by age group, above optimal thresholds were cost-effective in adults aged 30–59 years but not in those aged 60–75 years. The threshold strategies based on soft ASCVD model were mostly cost-saving compared with those based on hard models to treat the same proportions of the population. Conclusions The risk threshold of 18% for soft ASCVD model and 10% for hard ASCVD model have acceptable cost-utility profiles in the Chinese population. The soft ASCVD model is more cost-effective than the hard model and should be used as a screening tool for ASCVD primary prevention.https://doi.org/10.1186/s12916-025-04222-8Cardiovascular diseaseCost-utility analysisPrimary preventionHydroxymethylglutaryl-CoA reductase inhibitorsChina |
| spellingShingle | Zhijia Sun Haijun Zhang Yinqi Ding Canqing Yu Dianjianyi Sun Yuanjie Pang Pei Pei Ling Yang Yiping Chen Huaidong Du Dan Huang Xiaoming Yang Maxim Barnard Robert Clarke Junshi Chen Zhengming Chen Liming Li Jun Lv on behalf of the China Kadoorie Biobank Collaborative Group Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis BMC Medicine Cardiovascular disease Cost-utility analysis Primary prevention Hydroxymethylglutaryl-CoA reductase inhibitors China |
| title | Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis |
| title_full | Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis |
| title_fullStr | Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis |
| title_full_unstemmed | Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis |
| title_short | Risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among Chinese adults: a cost-utility analysis |
| title_sort | risk thresholds for soft versus hard cardiovascular disease outcome models for initiating statin therapy among chinese adults a cost utility analysis |
| topic | Cardiovascular disease Cost-utility analysis Primary prevention Hydroxymethylglutaryl-CoA reductase inhibitors China |
| url | https://doi.org/10.1186/s12916-025-04222-8 |
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