Expanding Statin Treatment Could be Cost-Effective and Prevent ASCVD Events

August 29, 2019
Patrick Campbell

A recent study found that expanding statin treatment to those with borderline risk of atherosclerotic cardiovascular disease and high LDL-C levels could prevent ASCVD events and be cost-effective on a population level.

A recent study has found that extending statin therapy to all patients with borderline risk of atherosclerotic cardiovascular disease (ASCVD) could be cost-effective and prevent most ASCVD events in patients with high LDL-C.

In an effort to assess the cost-effectiveness of expanding statin therapy to patients with borderline 10-year absolute risk (AR10) of ASCVD and elevated levels of LDL-C was effective, investigators carried out a microsimulation of 100 cohorts created from probabilistic sampling of the 1999 to 2014 US National Health and Nutrition Examination Surveys. Using a model that estimates lifetime individual-level survival, health0related quality of life, and costs of different statin treatment strategies.

All simulations included 1 million patients aged 40 years at baseline and all individuals started simulations without ASCVD and each year were at risk of coronary heart disease, stroke, combined coronary heart disease and stroke, or death. The simulations accounted for annual ASCVD event risk through time-varying risk factor exposures and for competing non-ASCVD mortality risk. Risk factors exposures included age, sex, race BMI, systolic blood pressure, LDL-C level, high-density lipoprotein cholesterol level, smoking, and diabetes.

AR10 was calculated at 40 years of age using the 2013 American College of Cardiology and American Heart Association 10-year CVD risk score and updated every 5 years in untreated patients to inform decisions.

Four statin treatments were compared in the investigators’ analyses. Those strategies included treating all patients with AR10 of at least 7.5%, diabetes or LDL-C of at least 190 mg/dL, adding treatment for borderline risk and LDL-C levels of 160 to 189 mg/dL, adding treatment for borderline risk and LDL-C levels of 130 to 159 mg/dL, and adding treatment for remainder of patients with AR10 of at least 5%. Investigators also compared statin treatment with no statin treatment in ages, sex, AR10, and LDL-C strata.

The primary outcome measure of the study was the incremental cost-effectiveness ratio. Lifetime quality-adjusted life-years (QALY) and costs were projected and discounted 3% annually as part of the analysis.

When comparing cohorts and outcomes without statin treatment, investigators found mean AR10 increased from 1.8% at 40 years of age to 7.4% at 60 years of age. Additionally, investigators noted mean LDL-C levels increased from 125.8 mg/dL at 40 to 126.9 mg/dL at 50 and then deceased to 122.3 mg/dL at 60 years of age. Without statin treatment, 5.3% of the cohort was projected to have an incident ASCVD event by 50 and 12.6% by 60 years of age.

When projecting the impact of expanded statin treatment to include individuals with borderline risk, would prevent an estimated 1200 to 5400 ASCVD events and investigators noted a gain of 1200 to 3200 QALYs per 1 million individuals treated. Similar relative event reductions were noted to occur for 10 years.

Investigators also found adding coder-intensity statin treatment of borderline AR10 and LDL-C levels between 160 and 189 mg/dL would be cost-saving compared to current standards. Additionally, investigators noted treating borderline AR10 with LDL-C levels of 130 to 159 mg/dL would be highly cost-effective in women ($18,487 per GALY gained).

Within their discussion, investigators noted the belief that treating all patients with borderline AR10 risk would be highly effective if society was willing to devote significant health care resources to the fight against ASCVD. 

This study, “Cost-effectiveness of Low-density Lipoprotein Cholesterol Level—Guided Statin Treatment in Patients With Borderline Cardiovascular Risk,” was published online in JAMA Cardiology.