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

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.