Abstract 227: Estimating the Value of Effective Lipid Management in China

Abstract

Background: Increasingly sedentary lifestyles and dietary changes associated with economic development in China, combined with progress in the treatment of infectious disease have resulted in a shift in the disease burden - the so-called epidemiological transition. Cardiovascular disease (CVD), including coronary heart disease (CHD) and other non-communicable diseases now play an increasingly important role in the disease burden faced by China. However, little is known about the future burden of CHD morbidity and mortality, as well as the cost-effectiveness of particular CHD-prevention policies in China. Objectives: To estimate the impact of aging and epidemiological transition on the burden of CHD morbidity and mortality over the next 15 years in China and to estimate the net value of effective lipid management. Methods: First, we estimate the prevalence of CHD and other risk factors based on the China Health and Nutrition Survey. Next, using prediction from the literature regarding trends in demographic and cardiovascular risk factors, such as elevated low-density lipoprotein cholesterol (LDL-C), we model how CHD risk will evolve between 2015 and 2030. We then estimate how expanded use of statins for lipid management over the next 15 years would alter the prevalence of elevated LDL-C as a risk factor, and determine how this would dampen the future growth in CHD burden. Accounting for the costs of statin use, we assess the net value of a policy that expands statin utilization for lipid management in China. Results: We find that - left unchecked - rising prevalence of CHD risk factors and the aging of the Chinese population will lead to the incidence of heart attacks rising from 4 million in 2015 to over 6 million in 2030. Similarly, the number of CHD deaths will rise from 1.3 million in 2015 to over 2 million in 2030. Treating all hyperlipidemia patients with statins would avert 10.5 million heart attacks and 3.5 million CHD deaths between 2015 and 2030. Based on current estimates of treatment costs in China and the cost of statins, we predict that such a policy would produce a net social value of $176 to $226 billion over the next 15 years. Conclusions: In light of its aging population and continued economic development, China faces near-certain increases in the incidence of CHD morbidity and mortality. Preventative measures such as effective lipid management may reduce the CVD burden substantially and also provide large social value to the society. At a time when the Chinese government is taking steps towards a more systematic approach to health care delivery, primary and secondary prevention of CVD should be high on the agenda.