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Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States

2015; American College of Physicians; Volume: 162; Issue: 8 Linguagem: Inglês

10.7326/m14-1430

1539-3704

Michelle C. Odden, Mark J. Pletcher, Pamela G. Coxson, Divya Thekkethala, David Guzman, David J. Heller, Lee Goldman, Kirsten Bibbins‐Domingo,

Pharmaceutical Practices and Patient Outcomes

Background: Evidence to guide primary prevention in adults aged 75 years or older is limited. Objective: To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. Design: Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. Data Sources: Trial, cohort, and nationally representative data sources. Target Population: U.S. adults aged 75 to 94 years. Time Horizon: 10 years. Perspective: Health care system. Intervention: Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. Outcome Measures: Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. Results of Base-Case Analysis: All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. Results of Sensitivity Analysis: An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. Limitation: Limited trial evidence targeting primary prevention in adults aged 75 years or older. Conclusion: At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. Primary Funding Source: American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.