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Statin treatment for borderline 10-year ASCVD risk appears to be cost-effective
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Lifetime statin treatment in a hypothetical cohort of patients with borderline atherosclerotic CVD risk and LDL levels between 160 mg/dL and 189 mg/dL was determined to be cost saving, according to a study published in JAMA Cardiology.
In addition, treating everyone with 10-year atherosclerotic CVD risk of at least 5% with statins was cost-effective — $33,558 per quality-adjusted life year — regardless of baseline LDL level, the researchers found.
Ciaran N. Kohli-Lynch, MS, research scientist in the division of general medicine at Columbia University Medical Center, and colleagues assessed 100 simulated cohorts, each of which consisted of 1 million patients (50% women) aged 40 years at baseline and free from ASCVD. These cohorts were created through probabilistic sampling from the 1999-2014 National Health and Nutrition Examination Surveys.
Using a computer simulation model, estimates were generated included lifetime individual-level survival, costs of different statin treatment strategies and health-related quality of life. Annual ASCVD risk was also estimated with time-varying risk factor exposures such as BMI, systolic BP, LDL, HDL, smoking and diabetes.
Four statin-initiation strategies were compared in the study, which incrementally expanded eligibility for treatment:
- Patients with a 10-year absolute risk of at least 7.5%, diabetes or an LDL of at least 190 mg/dL,
- Adding moderate-intensity statins for patients with a 10-year absolute risk between 5% and 7.4% and an LDL between 160 mg/dL and 189 mg/dL,
- Adding moderate-intensity statins for patients with a 10-year absolute risk between 5% and 7.4% and an LDL between 130 mg/dL and 159 mg/dL, and
- Adding moderate-intensity statins patients with a 10-year absolute risk of at least 5% regardless of their LDL level.
Cost savings were seen when preventive statins were given to patients with borderline 10-year absolute risk and LDL levels between 160 mg/dL to 189 mg/dL. This was also seen with further treatment in patients with borderline 10-year absolute risk and an LDL between 130 mg/dL and 159 mg/dL.
The treatment of patients with 10-year absolute risk of at least 5% regardless of LDL level was determined to be cost-effective, with an incremental cost-effectiveness ratio of $33,558 per QALY. Most ASCVD events would be prevented with this treatment approach, the researchers wrote.
More QALYs were gained from statin therapy in patients with higher baseline LDL levels within 10-year absolute risk, age and sex categories. Cost-effectiveness of statin therapy increased as 10-year absolute risk and LDL levels increased.
“Our results further suggest that treating all patients with borderline [10-year absolute risk] would be highly cost-effective if society is willing to devote significant health care resources toward ASCVD prevention,” Kohli-Lynch and colleagues wrote. – by Darlene Dobkowski
Disclosures: Kohli-Lynch reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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