Primary prevention statin medication is often prioritized in cholesterol recommendations based on a 10-year risk of cardiovascular disease. With the introduction of generic prices, statin eligibility may be expanded. Furthermore, the 10-year risk may not be the best technique for prioritizing statins. From a health sector viewpoint, researchers calculated the cost-effectiveness of increasing preventative statin eligibility and examined new approaches to prioritizing. In people aged 40, a computer simulation model projected long-term health and cost results. The Heart Health Extended Cohort, Morbidity Records, and National Records were used for the epidemiologic study. Data from the Health Survey 2011 and current population estimates were used to create a simulation cohort. Inputs for treatment and costs were collected from published literature and healthcare cost data. The primary outcome metric was the lifetime incremental cost-effectiveness ratio, which was calculated as the cost (2020 GBP) per quality-adjusted life-year (QALY) gained. The investigators looked at three approaches to statin prioritization: 10-year risk scoring using the ASSIGN score, age-stratified risk thresholds to increase treatment rates in younger people, and absolute risk reduction (ARR)–guided therapy to increase treatment rates in people with high cholesterol levels. Two strategies were explored for each approach: treating the same number of people as those with an ASSIGN score of ≥20% (age-stratified risk threshold 20, ARR 20) and treating the same number of people as those with an ASSIGN score of ≥10% (age-stratified risk threshold 10, ARR 10).
When compared to an ASSIGN score of ≥20%, lowering the risk threshold for statin beginning to 10% increased eligibility from 804,000 (32% of adults ≥40 years of age without CVD) to 1,445,500 people (58%). The strategy would be cost-effective (incremental cost-effectiveness ratio: £12 300/QALY [95% CI: £7,690/QALY–£26,500/QALY]). ARR 20 delivered ≈8800 QALYs incremental to an ASSIGN score of ≥20% and was cost-effective (£7,050/QALY [95% CI, £4,560/QALY–£10,700/QALY]). ARR 10 created ≈7950 QALYs and was cost-effective (£11,700/QALY [95% CI, £9,250/QALY–£16,900/QALY] when added to an ASSIGN score of ≥10%. Both risk threshold techniques based on age were dominant (ie, more expensive and less effective than alternative treatment strategies). Because of generic affordability, more individuals may now afford preventative statin medication. ARR–guided treatment is more successful and less expensive than a 10-year risk score.
Reference:www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057631
