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Evaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke.
Pubmed ID: 28687710
Pubmed Central ID: PMC5605438
Journal: Circulation
Publication Date: Sept. 19, 2017
Affiliation: From Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.). bibbinsk@medicine.ucsf.edu.
MeSH Terms: Humans, Male, Adult, Female, Aged, Aged, 80 and over, Hydroxymethylglutaryl-CoA Reductase Inhibitors, United States, Middle Aged, Coronary Disease, Quality of Life, Practice Guidelines as Topic, Stroke, Cholesterol, LDL, Cost-Benefit Analysis, Monte Carlo Method, American Heart Association
Grants: K01 AG039387, K24 DK103992, R01 HL107475
Authors: Pletcher MJ, Bibbins-Domingo K, Goldman L, Coxson PG, Odden MC, Penko J, Kazi DS, Heller DJ
Cite As: Heller DJ, Coxson PG, Penko J, Pletcher MJ, Goldman L, Odden MC, Kazi DS, Bibbins-Domingo K. Evaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke. Circulation 2017 Sep 19;136(12):1087-1098. Epub 2017 Jul 7.
Studies:
Abstract
BACKGROUND: Statins are effective in the primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline expands recommended statin use, but its cost-effectiveness has not been compared with other guidelines. METHODS: We used the Cardiovascular Disease Policy Model to estimate the cost-effectiveness of the ACC/AHA guideline relative to current use, Adult Treatment Panel III guidelines, and universal statin use in all men 45 to 74 years of age and women 55 to 74 years of age over a 10-year horizon from 2016 to 2025. Sensitivity analyses varied costs, risks, and benefits. Main outcomes were incremental cost-effectiveness ratios and numbers needed to treat for 10 years per quality-adjusted life-year gained. RESULTS: Each approach produces substantial benefits and net cost savings relative to the status quo. Full adherence to the Adult Treatment Panel III guideline would result in 8.8 million more statin users than the status quo, at a number needed to treat for 10 years per quality-adjusted life-year gained of 35. The ACC/AHA guideline would potentially result in up to 12.3 million more statin users than the Adult Treatment Panel III guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 68. Moderate-intensity statin use in all men 45 to 74 years of age and women 55 to 74 years of age would result in 28.9 million more statin users than the ACC/AHA guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 108. In all cases, benefits would be greater in men than women. Results vary moderately with different risk thresholds for instituting statins and statin toxicity estimates but depend greatly on the disutility caused by daily medication use (pill burden). CONCLUSIONS: At a population level, the ACC/AHA guideline for expanded statin use for primary prevention is projected to treat more people, to save more lives, and to cost less compared with Adult Treatment Panel III in both men and women. Whether individuals benefit from long-term statin use for primary prevention depends more on the disutility associated with pill burden than their degree of cardiovascular risk.