Work

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

Year: 2026

Type: article

Abstract: 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.

Source: BMC Health Services Research

DOI: 10.1186/s12913-026-15173-y