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Abstracts and presentations are embargoed for release at date and time of presentation or time of AHA/ASA news event. Information may not be released before then. Failure to honor embargo policies will result in the abstract being withdrawn and barred from presentation.
Moderated Poster Abstract PresentationsSession Title: Prognosis and Outcomes

Abstract MP43: The Population Impact and Cost-Effectiveness of Statins for Primary Prevention in Adults 75 and Older in the United States

Michelle C Odden, Pamela Coxson, Divya Thekkethala, Mark Pletcher, Kirsten Bibbins-Domingo
Circulation. 2014;129:AMP43
Michelle C Odden
Oregon State Univ, Corvallis, OR
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Pamela Coxson
Univ of California, San Francisco, San Francisco, CA
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Divya Thekkethala
Oregon State Univ, Corvallis, OR
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Mark Pletcher
Univ of California, San Francisco, San Francisco, CA
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Kirsten Bibbins-Domingo
Univ of California, San Francisco, San Francisco, CA
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Abstract

Introduction: Several investigations have evaluated the cost effectiveness of a low density lipoprotein (LDL) cholesterol “threshold” treatment strategy compared with a “risk-based” strategy based on a person’s 10-year risk of coronary heart disease (CHD). No studies to date have focused on adults 75 years and older.

Methods: Based on the Cardiovascular Disease Policy Model, a Markov model of the U.S. population, we forecasted the population impact of statin therapy over 10 years in adults aged 75-94 years. We compared two strategies for statin therapy in adults 75-94 years free of prevalent CHD and stroke: 1) treatment in anyone with LDL cholesterol >100 mg/dL in diabetics, and >130 mg/dL in non-diabetics, and 2) high intensity statins for persons with a 10-year CHD risk of >20% and low intensity statin for persons with a risk of 10-20%, independent of LDL cholesterol level. We assumed the use of low-cost statins ($4 per month), 100% adherence, 3% discounting/year, and costs from a healthcare perspective.

Results: The threshold strategy would treat an additional 50 million elders and prevent 99,000 incident myocardial infarctions and 55,000 CHD deaths at a cost of $ 1.4 billion, whereas the risk-based strategy would treat 103 million and prevent 143,000 incident myocardial infarctions and 97,000 CHD deaths at a cost of $ 7.8 billion. The threshold strategy is more cost-effective than the risk-based strategy ($4,300 vs. $18,000 per quality-adjusted life year gained).

Conclusions: A risk-based strategy prevents more events compared with a threshold strategy due to the large proportion of older adults who have high 10-year CHD risk scores, but is less efficient than a threshold strategy in adults 75 years and older.


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  • Lipids
  • Elderly
  • Cost-effectiveness
  • Author Disclosures: M.C. Odden: None. P. Coxson: None. D. Thekkethala: None. M. Pletcher: None. K. Bibbins-Domingo: None.

  • This research has received full or partial funding support from the American Heart Association, Western States Affiliate (California, Nevada & Utah).

  • © 2014 by American Heart Association, Inc.
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March 25, 2014, Volume 129, Issue Suppl 1
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    Abstract MP43: The Population Impact and Cost-Effectiveness of Statins for Primary Prevention in Adults 75 and Older in the United States
    Michelle C Odden, Pamela Coxson, Divya Thekkethala, Mark Pletcher and Kirsten Bibbins-Domingo
    Circulation. 2014;129:AMP43, originally published March 19, 2014

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    Abstract MP43: The Population Impact and Cost-Effectiveness of Statins for Primary Prevention in Adults 75 and Older in the United States
    Michelle C Odden, Pamela Coxson, Divya Thekkethala, Mark Pletcher and Kirsten Bibbins-Domingo
    Circulation. 2014;129:AMP43, originally published March 19, 2014
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