ArticleBMC health services research2026
Cost-effectiveness of statin-based primary prevention of cardiovascular disease with electronic pillboxes for people with HIV in China.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesCardiovascular 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.
methodsWe 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.
resultsRisk-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.
conclusionsRisk-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.
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