COST-EFFECTIVENESS OF LIPOPROTEIN(A) TESTING FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASES IN INDIA
Author(s)
Archana Thakur, MD1, Somen Saha, PhD1, Jinyi Zhu, PhD2, Dhaval Parmar, Sr., PhD1, Devang R. Raval, Sr., MPH1, Junaid KP, PhD1, Ashna Pandya, MD3, Astha Vala, MD4, Dr A. M. Kadri, MD4.
1Health Technology Assessment, Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India, 2Vanderbilt University Medical Center, Nashville, TN, USA, 3Pharmacology, GMERS Medical College, Sola, Gujarat, India, 4Health & Family Welfare Department, State Health System Resource Centre-Gujarat, Gandhinagar, India.
1Health Technology Assessment, Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India, 2Vanderbilt University Medical Center, Nashville, TN, USA, 3Pharmacology, GMERS Medical College, Sola, Gujarat, India, 4Health & Family Welfare Department, State Health System Resource Centre-Gujarat, Gandhinagar, India.
OBJECTIVES: The cost-effectiveness analysis compared three strategies: (i) one-time LP(a) testing with subsequent statin therapy for individuals with elevated LP(a), high CVD risk (≥20% 10-year WHO/ISH risk), and/or diabetes mellitus; (ii) statin initiation based solely on WHO/ISH risk stratification and diabetes status, consistent with WHO HEART technical guidelines; and (iii) standard care in India, i.e., statin therapy to individuals with diabetes only (irrespective of LDL-C levels), assuming a simplified, low-treatment status quo.
METHODS: A hybrid decision-analytic model combining a decision tree and a state-transition model was developed to estimate lifetime costs and health outcomes for a cohort of 100,000 individuals aged 40-69 years from a health-system perspective. Health outcomes included CVD cases prevented, deaths averted, life-years gained, and quality-adjusted life years (QALYs). Costs and outcomes were adjusted for statin adherence, assumed to be 20% under standard care (as informed by published evidence) and 50% under the WHO and LP(a)-guided strategies, reflecting the assumption that more systematic and protocol-driven screening would improve screening uptake and coverage. Sensitivity analyses were performed to assess model robustness.
RESULTS: In the base-case analysis, the WHO strategy was cost-saving and dominant compared with standard care, resulting in net savings of US$0.19 million, and gains of 1426 life-years and 1177 QALYs. Compared with the WHO strategy, the LP(a)-guided strategy resulted in 2351 life-years and 2093 QALYs at an additional cost of US$2.3 million, yielding an ICER of US$1103/QALY gained. With higher statin adherence [~80%], the WHO strategy remained cost-saving and dominant, while the ICER for the LP(a)-guided strategy improved to US$885/QALY. PSA showed that the LP(a)-guided strategy had the highest probability (65.9%) of being cost-effective at India’s current willingness-to-pay threshold of US$2,800/QALY.
CONCLUSIONS: An LP(a)-guided strategy is likely to be cost-effective for reducing the CVD burden in India at the current WTP threshold, although some uncertainty remains.
METHODS: A hybrid decision-analytic model combining a decision tree and a state-transition model was developed to estimate lifetime costs and health outcomes for a cohort of 100,000 individuals aged 40-69 years from a health-system perspective. Health outcomes included CVD cases prevented, deaths averted, life-years gained, and quality-adjusted life years (QALYs). Costs and outcomes were adjusted for statin adherence, assumed to be 20% under standard care (as informed by published evidence) and 50% under the WHO and LP(a)-guided strategies, reflecting the assumption that more systematic and protocol-driven screening would improve screening uptake and coverage. Sensitivity analyses were performed to assess model robustness.
RESULTS: In the base-case analysis, the WHO strategy was cost-saving and dominant compared with standard care, resulting in net savings of US$0.19 million, and gains of 1426 life-years and 1177 QALYs. Compared with the WHO strategy, the LP(a)-guided strategy resulted in 2351 life-years and 2093 QALYs at an additional cost of US$2.3 million, yielding an ICER of US$1103/QALY gained. With higher statin adherence [~80%], the WHO strategy remained cost-saving and dominant, while the ICER for the LP(a)-guided strategy improved to US$885/QALY. PSA showed that the LP(a)-guided strategy had the highest probability (65.9%) of being cost-effective at India’s current willingness-to-pay threshold of US$2,800/QALY.
CONCLUSIONS: An LP(a)-guided strategy is likely to be cost-effective for reducing the CVD burden in India at the current WTP threshold, although some uncertainty remains.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HTA1
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)