OBJECTIVES: The authors sought to evaluate the cost-effectiveness of statins for 
primary prevention of myocardial infarction (MI) and stroke in patients with 
chronic kidney disease (CKD).
BACKGROUND: Patients with CKD have an elevated risk of MI and stroke. Although 
HMG Co-A reductase inhibitors (“statins”) may prevent cardiovascular events in 
patients with non–dialysis-requiring CKD, adverse drug effects and competing 
risks could materially influence net effects and clinical decision-making.
METHODS: We developed a decision-analytic model of CKD and cardiovascular 
disease (CVD) to determine the cost-effectiveness of low-cost generic statins 
for primary CVD prevention in men and women with hypertension and 
mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted 
quality-adjusted life years (QALYs) and lifetime costs (2010 USD), and 
incremental cost-effectiveness ratios.
RESULTS: For 65-year-old men with moderate hypertension and mild-to-moderate 
CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and 
increased costs by $1,800 ($18,000 per QALY gained). For patients with lower 
baseline cardiovascular risks, health and economic benefits were smaller; for 
65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 
($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and 
drug costs. Statins are less cost-effective when obtained at average retail 
prices, particularly in patients at lower CVD risk.
CONCLUSIONS: Although statins reduce absolute CVD risk in patients with CKD, the 
increased risk of rhabdomyolysis, and competing risks associated with 
progressive CKD, partly offset these gains. Low-cost generic statins appear 
cost-effective for primary prevention of CVD in patients with mild-to-moderate 
CKD and hypertension.