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Objectives <p>Cardiovascular disease (CVD) is the leading non-AIDS cause of death among people with HIV (PWH). Although statins reduce CVD risk by over one-third, poor adherence limits real-world effectiveness. Electronic pillboxes may bridge this gap, but their cost-effectiveness for CVD primary prevention in PWH remains unclear.</p> Methods <p>We developed a Markov cohort model simulating 100,000 Chinese PWH (aged 40–75 years) over a lifetime horizon from a healthcare system perspective. Strategies varied by CVD screening frequency (every 6/12/24 months), lipid-lowering regimens (pitavastatin alone, or combined with ezetimibe or PCSK9 inhibitor), and electronic pillbox adherence support for high-risk individuals. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per quality-adjusted life-year (QALY) gained versus status quo at willingness-to-pay thresholds of 1 × and 3 × GDP per capita ($13,445 and $40,335) in China.</p> Results <p>Risk-stratified screening every 24 months with pitavastatin alone (without pillboxes) was optimal at 1×GDP per capita (ICER $8,269/QALY), averting 4,298 major adverse cardiovascular events (MACE) and gaining 28,570 QALYs versus status quo. At 3×GDP per capita, 6-monthly screening with risk-tailored therapy (pitavastatin ± ezetimibe) plus electronic pillboxes was optimal (ICER $16,799/QALY), averting 10,169 MACE and gaining 59,125 QALYs. Statin adherence and ezetimibe cost were key drivers of cost-effectiveness.</p> Conclusions <p>Risk-stratified CVD prevention integrating periodic screening and tailored pharmacotherapy is cost-effective for PWH in China. Electronic pillboxes become cost-effective when greater healthcare investment is available, supporting a threshold-dependent approach to translating statin efficacy into population-level impact.</p>

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Cost-effectiveness of statin-based primary prevention of cardiovascular disease with electronic pillboxes for people with HIV in China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Yuxuan Li,
  • Wanqing Huang,
  • Lili Cui,
  • Dongmei Zhong,
  • Dong Roman Xu,
  • Hongwei Zhou,
  • Rui Zhao

摘要

Objectives

Cardiovascular disease (CVD) is the leading non-AIDS cause of death among people with HIV (PWH). Although statins reduce CVD risk by over one-third, poor adherence limits real-world effectiveness. Electronic pillboxes may bridge this gap, but their cost-effectiveness for CVD primary prevention in PWH remains unclear.

Methods

We developed a Markov cohort model simulating 100,000 Chinese PWH (aged 40–75 years) over a lifetime horizon from a healthcare system perspective. Strategies varied by CVD screening frequency (every 6/12/24 months), lipid-lowering regimens (pitavastatin alone, or combined with ezetimibe or PCSK9 inhibitor), and electronic pillbox adherence support for high-risk individuals. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per quality-adjusted life-year (QALY) gained versus status quo at willingness-to-pay thresholds of 1 × and 3 × GDP per capita ($13,445 and $40,335) in China.

Results

Risk-stratified screening every 24 months with pitavastatin alone (without pillboxes) was optimal at 1×GDP per capita (ICER $8,269/QALY), averting 4,298 major adverse cardiovascular events (MACE) and gaining 28,570 QALYs versus status quo. At 3×GDP per capita, 6-monthly screening with risk-tailored therapy (pitavastatin ± ezetimibe) plus electronic pillboxes was optimal (ICER $16,799/QALY), averting 10,169 MACE and gaining 59,125 QALYs. Statin adherence and ezetimibe cost were key drivers of cost-effectiveness.

Conclusions

Risk-stratified CVD prevention integrating periodic screening and tailored pharmacotherapy is cost-effective for PWH in China. Electronic pillboxes become cost-effective when greater healthcare investment is available, supporting a threshold-dependent approach to translating statin efficacy into population-level impact.