Cost-effectiveness of low-density lipoprotein cholesterol-lowering therapeutic interventions for the primary prevention of cardiovascular disease based on patient characteristics

• Project/Area Number: 17K08945
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Medical sociology
• Research Institution: National Cardiovascular Center Research Institute
• Principal Investigator: Takegami Misa 国立研究開発法人国立循環器病研究センター, 研究所, 室長 (50456860)
• Co-Investigator(Kenkyū-buntansha): 森脇 健介 立命館大学, 総合科学技術研究機構, 准教授 (10514862)
• Project Period (FY): 2017-04-01 – 2021-03-31
• Project Status: Completed (Fiscal Year 2020)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2019: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2018: ¥2,210,000 (Direct Cost: ¥1,700,000、Indirect Cost: ¥510,000); Fiscal Year 2017: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 脂質低下療法 / 脂質異常症 / 費用対効果 / 一次予防

Outline of Final Research Achievements

The clinical efficacy of lipid-lowering therapy in the treatment of cardiovascular disease is clear. Nonetheless, there is controversy regarding which patients should receive lipid-lowering therapy for primary prevention in Japan, where the incidence of cardiovascular disease is lower than in Europe and the United States. In this study, we examined the effect of lipid-lowering therapy on the primary prevention of cardiovascular disease from a socioeconomic perspective, using evidence from epidemiological studies in Japan. The results of the cost-effectiveness analysis using a Markov model suggested that the cost-effectiveness of lipid-lowering therapy was low in subjects with no cardiovascular disease risk, other than hypercholesterolemia, based on the willingness-to-pay amount in Japan. The cost-effectiveness of lipid-lowering therapy differs substantially according to the level of cardiac risk.

Academic Significance and Societal Importance of the Research Achievements

脂質異常症の患者が増えるに従い、脂質低下療法の必要性が高まっている。心血管疾患の一次予防としての脂質低下療法をどのような患者に実施すべきかどうかは、臨床的な観点だけでなく、社会経済的な観点からの評価も必要である。脂質異常症の患者における心血管疾患の発症リスクは同じではなく、心血管疾患のリスク因子の保有により、心血管疾患の発症リスクは異なる。患者の脂質以外の心血管疾患のリスク因子を保有している患者およびリスク因子の保有パターンごとに脂質低下治療薬の費用対効果を検討した結果、治療の費用対効果が高い集団が明らかとなった。本研究の結果は、公衆衛生学的な予防・治療戦略上の意思決定の一助となる。

Research Products

• [Journal Article] The risk of fasting triglycerides and its-related indices for ischemic cardiovascular diseases in Japanese community-dwellers: the Suita study (2021)
  • Author(s): Higashiyama A, Wakabayashi I, Okamura T, Kokubo Y, Watanabe M, Takegami M, Honda-Kohmo K, Okayama A, Miyamoto Y.
  • Journal Title: Journal of Atherosclerosis and Thrombosis Volume: ー
  • NAID: 130008123369
  • Peer Reviewed / Open Access
• [Journal Article] Development of a Cardiovascular Disease Risk Prediction Model Using the Suita Study, a Population-Based Prospective Cohort Study in Japan (2020)
  • Author(s): Nakai M, Watanabe M, Kokubo Y, Nishimura K, Higashiyama A, Takegami M, Nakao YM, Okamura T, Miyamoto Y.
  • Journal Title: Journal of Atherosclerosis and Thrombosis Volume: 27 Issue: 11 Pages: 1160-1175
  • DOI: 10.5551/jat.48843
  • NAID: 130007933942
  • ISSN: 1340-3478, 1880-3873
  • Year and Date: 2020-11-01
  • Peer Reviewed / Open Access
• [Journal Article] Hypercholesterolemia and Lifetime Risk of Coronary Heart Disease in the General Japanese Population: Results from the Suita Cohort Study (2020)
  • Author(s): Sugiyama D, Turin TC, Yeasmin F, Rumana N, Watanabe M, Higashiyama A, Takegami M, Kokubo Y, Okamura T, Miyamoto Y.
  • Journal Title: Journal of Atherosclerosis and Thrombosis Volume: 27 Issue: 1 Pages: 60-70
  • DOI: 10.5551/jat.49098
  • NAID: 130007779018
  • ISSN: 1340-3478, 1880-3873
  • Year and Date: 2020-01-01
  • Peer Reviewed / Open Access
• [Journal Article] Hypercholesterolemia and lifetime risk of coronary heart disease in the general Japanese population: results from the Suita Cohort Study (2019)
  • Author(s): Sugiyama D, Turin TC, Yeasmin F, Rumana N, Wanatabe M, Higashiyama A, Takegami M, Kokubo Y, Okamura T, Miyamoto Y.
  • Journal Title: Journal of Atherosclerosis and Thrombosis Volume: 印刷中
  • NAID: 130007779018
  • Peer Reviewed
• [Journal Article] Longitudinal Trajectories of Fasting Plasma Glucose and Risks of Cardiovascular Diseases in Middle Age to Elderly People Within the General Japanese Population: The Suita Study. (2019)
  • Author(s): Ogata S, Watanabe M, Kokubo Y, Higashiyama A, Nakao YM, Takegami M, Nishimura K, Nakai M, Kiyoshige E, Hosoda K, Okamura T, Miyamoto Y.
  • Journal Title: Journal of the American Heart Association Volume: 8 Issue: 3
  • DOI: 10.1161/jaha.118.010628
  • Peer Reviewed / Open Access
• [Journal Article] Rationale, design, and baseline characteristics of the prospective Japan Acute Myocardial Infarction Registry (JAMIR). (2019)
  • Author(s): Honda S, Nishihira K, Kojima S, Takegami M, Asaumi Y, Suzuki M, Kosuge M, Takahashi J, Sakata Y, Takayama M, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S; JAMIR investigators.
  • Journal Title: Cardiovascular Drugs and Therapy Volume: 33 Issue: 1 Pages: 97-103
  • DOI: 10.1007/s10557-018-6839-1
  • Peer Reviewed
• [Journal Article] Nationwide real-world database of 20,462 patients enrolled in the Japanese Acute Myocardial Infarction Registry (JAMIR): Impact of emergency coronary intervention in a super-aging population. (2018)
  • Author(s): Kojima S, Nishihira K, Takegami M, Nakao YM, Honda S, Takahashi J, Takayama M, Shimokawa H, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S; JAMIR Investigators.
  • Journal Title: International Journal of Cardiology Heart & Vasculature Volume: 20 Pages: 1-6
  • DOI: 10.1016/j.ijcha.2018.06.003
  • Peer Reviewed
• [Journal Article] Diabetes and lifetime risk of coronary heart disease. (2017)
  • Author(s): Turin TC, Okamura T, Rumana N, Afzal AR, Watanabe M, Higashiyama A, Nakao YM, Nakai M, Takegami M, Nishimura K, Kokubo Y, Okayama A, Miyamoto Y.
  • Journal Title: Prim Care Diabetes Volume: 11 Issue: 5 Pages: 461-466
  • DOI: 10.1016/j.pcd.2017.04.007
  • Peer Reviewed
• [Journal Article] Diabetes and lifetime risk of stroke and subtypes in an urban middle-aged population. (2017)
  • Author(s): Turin TC, Okamura T, Rumana N, Afzal AR, Watanabe M, Higashiyama A, Nakao YM, Nakai M, Takegami M, Nishimura K, Kokubo Y, Okayama A, Miyamoto Y.
  • Journal Title: J Diabetes Complications Volume: 31 Issue: 5 Pages: 831-835
  • DOI: 10.1016/j.jdiacomp.2017.02.002
  • Peer Reviewed
• [Presentation] 肥満有無別の循環器疾患危険因子集積と循環器疾患発症リスクとの関連および集団寄与危険割合： 国内コホート研究のメタアナリシスより. (2018)
  • Author(s): 竹上未紗，東山綾，磯博康，今野弘規，三浦克之，宮澤伊都子，岡山明，丹野高三，岡村智教，宮本恵宏．
  • Organizer: 第54回日本循環器病予防学会学術集会