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Cost Analysis of Statin Therapy in Primary Prevention
Study Questions:
What are the incremental costs of statin therapy in primary prevention?
Methods:
Data from the National Health and Nutrition Examination Surveys (NHANES), large clinical trials, and meta-analyses were used to estimate numbers of adults and associated atherosclerotic cardiovascular disease (ASCVD) risk, as well as ASCVD event rates. Microsimulation models were created to estimate the cost-effectiveness of statin therapy among US adults, ages 40-75 years. In the models, the adults received statin therapy, experienced ASCVD events, and died from ASCVD-related or non–ASCVD-related causes. Risk scores were calculated every 5 years until eligibility for statin therapy was met. Patients in the disease-free state who received statin therapy were estimated to have coronary heart disease and stroke risks of 0.75 and 0.81, respectively. Costs included in the model incorporated CVD event costs, statin costs, and costs related to labs, clinic visits, and screening. The primary outcome of interest was estimated ASCVD events prevented and incremental costs per quality-adjusted life-years (QALYs) gained.
Results:
Using the current ASCVD threshold of 7.5% or higher for statin treatment, which was estimated to be associated with 48% of adults treated with statins, the incremental cost-effectiveness ratio was $37,000/QALYs compared with a 10% or higher threshold. Lower thresholds of 4.0% or higher (61% of adults treated) had an incremental cost-effectiveness ratio of $81,000/QALY. For a threshold of 3.0% or higher (67% of adults treated), an incremental cost-effectiveness ratio of $140,000/QALY was calculated. A shift from 7.5% or higher ASCVD risk threshold to 3.0% threshold was associated with an estimated additional 161,560 cardiovascular events avoided. Cost-effectiveness estimates were influenced by change in the disutility associated with taking a daily medication, statin price, and risk of statin-induced diabetes.
Conclusions:
The investigators concluded that in these microsimulation models of US adults (ages 40-75 years), the current 10-year ASCVD risk threshold of 7.5% or greater has an acceptable cost-effectiveness profile ($37,000/QALY incremental cost-effectiveness ratio). However, more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100,000/QALY (≥4.0% risk) or $150,000/QALY (≥3.0% risk). The optimal ASCVD threshold was sensitive to patient preferences for taking a pill daily, changes in statin price, and risk of statin-induced diabetes.
Perspective:
This analysis highlights the cost-effectiveness of statin therapy in US adults and supports the current recommended threshold of 7.5% 10-year ASCVD risk for consideration of statin therapy. However, as the current recommendations point out, it remains important to have a discussion regarding the risks and benefits related to each individual patient.
Keywords: Atherosclerosis, Coronary Artery Disease, Cost-Benefit Analysis, Diabetes Mellitus, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Primary Prevention, Quality-Adjusted Life Years, Risk Assessment, Stroke
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