TitleEvaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke.
Publication TypeJournal Article
Year of Publication2017
AuthorsHeller, DJ, Coxson, PG, Penko, J, Pletcher, MJ, Goldman, L, Odden, MC, Kazi, DS, Bibbins-Domingo, K
JournalCirculation
Volume136
Issue12
Pagination1087-1098
Date Published2017 Sep 19
ISSN1524-4539
KeywordsAdult, Aged, Aged, 80 and over, American Heart Association, Cholesterol, LDL, Coronary Disease, Cost-Benefit Analysis, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Monte Carlo Method, Practice Guidelines as Topic, Quality of Life, Stroke, United States
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.

DOI10.1161/CIRCULATIONAHA.117.027067
Alternate JournalCirculation
PubMed ID28687710
PubMed Central IDPMC5605438
Grant ListK01 AG039387 / AG / NIA NIH HHS / United States
K24 DK103992 / DK / NIDDK NIH HHS / United States
R01 HL107475 / HL / NHLBI NIH HHS / United States