Objectives: Dyslipidemia is a major driver of cardiovascular disease (CVD), causing a global economic burden. Statins are the mainstay for reducing LDL-C, with pitavastatin (PIT) being the newest-generation statin, showing non-inferior efficacy compared with potent statins. This study aims to assess the cost-effectiveness of pitavastatin in comparison with atorvastatin (ATOR) and rosuvastatin (ROS). Method: The PubMed, Cochrane, and Embase databases were searched to identify full or partial economic evaluations through 19 November 2025. Our primary outcome is the incremental cost-effectiveness ratio (ICER), with health outcomes measured by quality-adjusted life years (QALYs) or percentage reduction in LDL-C. Regarding quality assessment, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 tool was applied. The Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) checklist and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) were performed for RCTs and non-RCT risk assessments, respectively. Result: Five studies were synthesized. One model-based analysis over a lifetime revealed that PIT was less expensive but generated slightly fewer QALYs than ATOR and was dominated by ROS. Four within-trial CEAs with follow-up ≤12 months found that for each 1% reduction in LDL-C, PIT was generally more economical than low-dose ATOR but consistently more costly than ROS. Conclusions: Because of the small number and heterogeneity of studies, it is not possible to draw firm conclusions about the cost-effectiveness of PIT. Further model-based analyses with an adequate sample size and comprehensive costing are needed to clarify the economic role of PIT.
Vo et al. (Thu,) studied this question.