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Peer-reviewedCC BY 4.0BMC Health Services Research

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

  • Yuxuan Li1
  • Wanqing Huang2
  • Lili Cui3
  • Dongmei Zhong4
  • Dong Roman Xu2,5
  • Hongwei Zhou6,7,8,9,10
  • Rui Zhao11
11 affiliations
  1. 1China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi 710061 China
  2. 2Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, 1023-1063, South Shatai Road, Guangzhou, Guangdong 510515 China
  3. 3West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu, 610041 China
  4. 4Dermatology Hospital, Southern Medical University, Guangzhou, China
  5. 5Center for World Health Organization Studies, School of Health Management, Southern Medical University, Guangzhou, Guangdong China
  6. 6Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
  7. 7Department of Obstetrics and Gynaecology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
  8. 8Guangdong Provincial Clinical Research Center for Laboratory Medicine, Guangzhou, China
  9. 9State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangzhou, China
  10. 10Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, 1333 Xinhu Road, Bao’an District, Shenzhen, 518000 China
  11. 11Shenzhen Hospital of Southern Medical University, 1333 Xinhu Road, Bao’an District, Shenzhen, Guangdong 518000 China
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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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15173-y.

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Cite

BibTeXRIS
BibTeX
@article{li2026costeffectiveness,
  title = {{Cost-effectiveness of statin-based primary prevention of cardiovascular disease with electronic pillboxes for people with HIV in China}},
  author = {Yuxuan Li and Wanqing Huang and Lili Cui and Dongmei Zhong and Dong Roman Xu and Hongwei Zhou and Rui Zhao},
  journal = {BMC Health Services Research},
  year = {2026},
  month = aug,
  doi = {10.1186/s12913-026-15173-y},
  url = {https://doi.org/10.1186/s12913-026-15173-y},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Cost-effectiveness of statin-based primary prevention of cardiovascular disease with electronic pillboxes for people with HIV in China
AU  - Yuxuan Li
AU  - Wanqing Huang
AU  - Lili Cui
AU  - Dongmei Zhong
AU  - Dong Roman Xu
AU  - Hongwei Zhou
AU  - Rui Zhao
PY  - 2026
DA  - 2026/08/04
JO  - BMC Health Services Research
DO  - 10.1186/s12913-026-15173-y
UR  - https://doi.org/10.1186/s12913-026-15173-y
AB  - 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15173-y.
SN  - 1472-6963
ER  -