Statin therapy for primary prevention is ‘cost-effective’
MedWire News: Aggressive statin treatment guidelines that target patients with modestly elevated low-density lipoprotein (LDL) cholesterol or any coronary heart disease (CHD) risk factors are cost-effective, as long as patients are willing to take a daily pill, say US researchers.
Writing in the journal Circulation, Mark Pletcher (University of California, San Francisco) and colleagues say: "If statins are widely available for US$4 (€2.8) per month and assumptions about their efficacy apply to low-risk subgroups, expanding statin indications for primary prevention beyond current guidelines would be cost-effective, with modest expansions actually saving money by preventing costly events."
The researchers considered different LDL cholesterol prescribing thresholds (>160, >130, and >100 mg/dl [>4.14, >3.37, and >2.59 mmol/l, respectively]) for four CHD risk groups: moderately high risk (≥two risk factors and 10-20% 10-year CHD risk), moderate risk (≥two risk factors and <10% 10-year CHD risk), lower risk (one risk factor), and lowest risk (no risk factors).
For each risk group they identified LDL thresholds at which treatment was cost-saving or cost-effective compared with treating at the next LDL cholesterol level.
Pletcher et al report that if statins cost US$4 (€2.8) per month and are efficacious in everybody over 35 years of age, treatment thresholds of LDL cholesterol above 160 mg/dl for low-risk people, 130 mg/dl for moderate-risk people, and 100 mg/dl for moderately-high risk people would be cost-saving or cost-effective.
They calculated that implementation of a cost-saving strategy - the broadest treatment expansion possible with cost-savings for all CHD risk groups - would prevent 14,000 CHD deaths per year and save over US$1.4 (€0.97) billion per year compared with current treatment guidelines.
Furthermore, full implementation of such a strategy, but with cost-effective treatment for all CHD risk groups rather than cost-saving treatment (the maximum-impact strategy) would prevent 6.3% of all CHD deaths. This strategy would start statin therapy for 64 million individuals at an estimated net cost of US$620 <€427.7) million per year, but would prevent 27,000 CHD deaths per year, making it highly cost-effective.
The researchers estimate that the maximum-impact strategy would have nearly four times the impact of full implementation of the National Cholesterol Education Program Adult Treatment Panel-III guidelines.
"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," write the authors.
However, "adverse effects are unlikely to outweigh benefits in any subgroup in which statins are found to be efficacious," they conclude.
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By Nikki Withers