Lost therapeutic benefit of delayed LDL-C control in statin treated patients and cost-effectiveness analysis of lipid-lowering intensification

Published:November 24, 2022DOI:
      This paper is only available as a PDF. To read, Please Download here.


      • -
        Most statin treated patients do not achieve LDL-C therapeutic targets, remaining at high risk of CHD; the lost therapeutic benefit and the economic impact of delaying target achievement is unclear.
      • -
        Delaying lipid-lowering intensification translates into worse health and economic outcomes compared to early and intense lipid lowering for statin treated individuals with uncontrolled LDL-C and no prior CVD.



      Attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health-economic impact of delayed lipid-lowering intensification from an Australian healthcare and societal perspective.


      A lifetime Markov cohort model (n = 1,000) estimating the impact on coronary heart disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients with uncontrolled LDL-C, at moderate-high risk of CHD with no delay or after a five-year delay, compared to standard of care (no intensification), starting at age 40. Intensification was tested with high-intensity statins or statins+ezetimibe. LDL-C levels were extracted from a primary care cohort. CHD risk was estimated using the Pooled Cohort Equation. The effect of cumulative exposure to LDL-C on CHD risk was derived from Mendelian randomisation data. Outcomes included CHD events, quality-adjusted life years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICER). All outcomes were annually discounted by 5%.


      Over the lifetime horizon, when compared to standard of care, achieving LDL-C control with no delay with high intensity statins prevented 29 CHD events and yield 30 extra QALYs (ICERs AU$13,205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20,270/QALY) with a five-year delay. For statins+ezetimibe, no delay prevented 53 CHD events and gave 45 extra QALYs (ICER AU$37,271/QALY) versus 40 CHD events and 29 QALYs (ICER of AU$44,218/QALY) after a five-year delay.


      Delaying attainment of LDL-C targets translates into lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in statin-treated patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Value in Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect