Cost-Effectiveness of Statin Therapy for Primary Prevention in a Low-Cost Statin Era

• Published in: Circulation (New York, N.Y.) Vol. 124; no. 2; pp. 146 - 153
• Main Authors: LAZAR, Lawrence D, PLETCHER, Mark J, COXSON, Pamela G, BIBBINS-DOMINGO, Kirsten, GOLDMAN, Lee
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 12.07.2011
• Subjects: Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Blood. Blood coagulation. Reticuloendothelial system; Cardiology. Vascular system; Cholesterol - blood; Coronary Disease - drug therapy; Coronary Disease - economics; Costs and Cost Analysis; Diabetes Mellitus - chemically induced; Diabetes Mellitus - economics; Diabetes Mellitus - therapy; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Medical sciences; Middle Aged; Models, Biological; Pharmacology. Drug treatments; Practice Guidelines as Topic; Risk Factors; Time Factors; United States; United States; Costs; Enzyme; Cardiovascular disease; Statin derivative; Cost benefit analysis; Coronary heart disease; Prevention; coronary disease; Treatment; cost-benefit analysis; Hydroxymethylglutaryl-CoA reductase; hydroxymethylglutaryl-CoA reductase inhibitors; Oxidoreductases; Cost efficiency analysis; Antilipemic agent
• DOI: 10.1161/circulationaha.110.986349
• ISSN: 0009-7322

With wide availability of low-cost generics, primary prevention with statins has become less expensive. We projected the cost-effectiveness of expanded statin prescribing strategies using low-cost generics and identified conditions under which aggressive prescribing ceases to be cost-effective. We simulated expanded statin prescribing strategies with the coronary heart disease policy model, a Markov model of the US population >35 years of age. If statins cost $4/mo, treatment thresholds of low-density lipoprotein cholesterol >160 mg/dL for low-risk persons (0 to 1 risk factor), >130 mg/dL for moderate-risk persons (≥2 risk factors and 10-year risk <10%), and >100 mg/dL for moderately high-risk persons (≥2 risk factors and 10-year risk >10%) would reduce annual healthcare costs by $430 million compared with Adult Treatment Panel III guidelines. Lowering thresholds to >130 mg/dL for persons with 0 risk factors and >100 mg/dL for persons with 1 risk factor and treating all moderate- and moderately high-risk persons regardless of low-density lipoprotein cholesterol would provide additional health benefits for $9900 per quality-adjusted life-year. These findings are insensitive to most adverse effect assumptions (including statin-associated diabetes mellitus and severe hypothetical effects) but are sensitive to large reductions in the efficacy of statins or to a long-term disutility burden for which a patient would trade 30 to 80 days of life to avoid 30 years of statins. Low-cost statins are cost-effective for most persons with even modestly elevated cholesterol or any coronary heart disease risk factors if they do not mind taking a pill daily. Adverse effects are unlikely to outweigh benefits in any subgroup in which statins are found to be efficacious.