Abstract 10485: Low Density Lipoprotein Cholesterol (LDL-C) Lowering in a Population Represented in a Meta-Analysis of Major Randomized Trials is Associated with a Positive Health-Economic Benefit
Introduction: LDL-C is a key target for lipid-lowering therapy and reduction in cardiovascular (CV) event risk. A recent meta-analysis of 26 major randomized trials comprising 170,000 subjects demonstrated 22% reduction in CV event risk for each 1 mmol/L reduction in LDL-C.
Hypothesis: LDL-C lowering in the population represented in the above meta-analysis is associated with higher quality adjusted life years (QALYs) and lower costs over patient's remaining lifetime.
Methods: A discrete-event simulation was developed with a hypothetical cohort of 170,000 subjects who initiated LDL-C lowering treatment at time t = 0. Each patient was probabilistically assigned to main reported subgroups. Mean subgroup characteristics were applied to individual patients. They included baseline risk of individual events, baseline LDL-C levels, and risk reduction for events per ΔLDL-C level reduction. Patients probabilistically transitioned to subsequent events until death. Costs and utilities associated with events were obtained from published sources. The model was intended to represent cost consequences exclusive of LDL-C lowering treatment costs; hence it did not include any intervention costs. Costs and QALYs were discounted at 3% annual rate. Cost data represented 2011 US$.
Results: Simulation results indicated decreasing LDL-C to levels reported in the meta-analysis (∼30% reduction) resulted in an increase in QALY/patient of 0.9, and a decline in remaining lifetime cost/patient of $4,700. Additional scenarios with 50% and 70% reduction in LDL-C levels resulted in an increase in QALY/patient of 1.5 and 2.2, respectively, and a decline in remaining lifetime cost/patient of $8,000 and $11,500 respectively.
Conclusions: LDL-C lowering in the studied population is associated with higher QALYs and lower costs over patient's remaining lifetime. The decline in costs despite an increase in patient survival points to potentially important cost-offsets from events avoided. Results suggest possible health-economic benefits of developing novel treatments for further LDL-C lowering. This conclusion is based on the assumption that the risk reduction benefits continue at lower LDL-C levels, the confirmation of which awaits results from ongoing clinical trials.
- © 2011 by American Heart Association, Inc.