Abstract | BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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.
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Authors | Lawrence D Lazar, Mark J Pletcher, Pamela G Coxson, Kirsten Bibbins-Domingo, Lee Goldman |
Journal | Circulation
(Circulation)
Vol. 124
Issue 2
Pg. 146-53
(Jul 12 2011)
ISSN: 1524-4539 [Electronic] United States |
PMID | 21709063
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Cholesterol
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Topics |
- Adult
- Aged
- Cholesterol
(blood)
- Coronary Disease
(drug therapy, economics)
- Costs and Cost Analysis
- Diabetes Mellitus
(chemically induced, economics, therapy)
- Female
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
(adverse effects, economics, therapeutic use)
- Middle Aged
- Models, Biological
- Practice Guidelines as Topic
- Risk Factors
- Time Factors
- United States
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