Abstract

Background Statins are the cornerstone treatment for the primary prevention of cardiovascular disease (CVD), but intolerance and side effects can hinder adherence. Berberine, with promising lipid-lowering effects and good tolerance, presents a potential alternative for statin-intolerant patients.

Aim To estimate and compare the cost-effectiveness of statins, berberine, and their combined use for primary CVD prevention.

Methods The Scottish CVD Policy Model was used to predict long-term health and cost outcomes in Scottish adults aged 40 years or older without pre-existing CVD. Intervention and cost inputs were sourced from published literature and health service cost data. The primary outcome measure was the lifetime incremental cost-effectiveness ratio (ICER), evaluated as cost per quality-adjusted life year (QALY) gained. The intervention strategies of no intervention, atorvastatin 20 mg per day (“statins”), berberine 1000 mg per day (“berberine”), simvastatin 20 mg plus berberine 1500 mg per day (“combined intervention 1”) and simvastatin 20 mg plus berberine 900 mg per day (“combined intervention 2”) were analyzed for individuals with ASSIGN risk scores ≥20% and ≥10%.

Results All intervention strategies were cost-effective (statins: ICER £1,260.7/QALY, 95%CI: £- 2,528.6/QALY ∼ £2,305.5/QALY; berberine: ICER £6,192.4/QALY, 95%CI: £4,655.7/QALY ∼ £11,387.0/QALY; combined intervention 1: ICER £5,506.5/QALY, 95%CI: £4,506.8/QALY ∼ £10,732.0/QALY; combined intervention 2: ICER £3,846.4/QALY, 95%CI: £3,107.0/QALY ∼ £5,270.1/QALY), compared to no intervention, at the threshold of ICER of £20,000 per QALY. Compared to statins, berberine was less cost-effective, but the combined interventions remained cost-effective (£10,198.6/QALY [95%CI: £6,740.4/QALY ∼ £58,473.3/QALY]; £6,362.8/QALY [95%CI: £5,187.7/QALY ∼ £12,499.2/QALY]) at the threshold of £20,000/QALY. Notably, when using drug costs from China (reflecting lower berberine prices), berberine and the combined interventions were preferable to statins alone.

Conclusions Statins, berberine, and combined interventions are all cost-effective options for primary CVD prevention. Berberine could be considered a valuable alternative or complementary therapy, particularly if its price decreases below that of statins.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This research was supported by AIR@InnoHK administered by Innovation and Technology Commission of The Government of the Hong Kong Special Administrative Region.

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Abbreviations ListCVDCardiovascular DiseaseCHDcoronary heart diseaseCBVDcerebrovascular diseaseSIMDScottish Index of Multiple DeprivationSBPSystolic Blood PressureTCTotal CholesterolHDL-cHigh-Density Lipoprotein CholesterolLDL-cLow-Density Lipoprotein Cholesterolnon–HDL-cnon-high-density lipoprotein cholesterolQALYquality-adjusted life-yearICERincremental cost-effectiveness ratioRCTrandomized clinical trial