OBJECTIVES: According to the 2017 Taiwan Lipid Treatment Guideline, the recommended target of LDL-C level has been lowered from 100 to 70mg/dL for patients with coronary artery disease (CAD), to prevent subsequent myocardial infarction (MI) or stroke. However, the reimbursement criteria do not reflect this change. We aimed to assess whether changing the reimbursement criteria is cost-effective from the perspective of the National Health Insurance Administration in Taiwan.

METHODS: A 10-year Markov cohort state-transition model was developed to simulate a hypothetical cohort of 10,000 CAD patients with baseline LDL-C level of 70-100mg/dL. The incidence of MI and stroke related to specific LDL-C levels, efficacy of statins and health state utilities were obtained from the literature. The direct medical costs were derived from the national claims database. Costs and health outcomes were discounted at 3% annually. One-way sensitivity analysis was used to assess uncertainty of the parameter estimates.

RESULTS: Moderate-intensity statin use versus no treatment could prevent 181 MIs, 331 strokes and 163 all-cause deaths, resulting in a net gain of 659 QALYs per 10,000 patients over 10 years. Statin therapy, while increasing drug expenditures (USD 16M), was associated with lower event-related costs (USD 5M), yielding a net cost of USD 11M. The incremental cost-effectiveness ratio (ICER) was USD 16,618 per QALY gained, which was less than a gross domestic product per capita (USD 24,337) in 2017 in Taiwan. Referring to the WHO-CHOICE criteria, statin therapy among the study cohort was considered to be ‘very cost-effective’. Sensitivity analysis showed the results were robust and the baseline LDL-C level was the most influential factor to the ICER.

CONCLUSIONS: Lowering the target LDL-C level from 100 to 70mg/dL among CAD patients is cost-effective given the health benefit in preventing cardiovascular events. This study has implications for reimbursement criteria modification and health policy implementation.