Highlights
- •Most statin-treated patients do not achieve low-density lipoprotein cholesterol therapeutic goals, remaining at high risk of coronary heart disease; the lost therapeutic benefit and the economic impact of delaying target achievement are unclear.
- •Delaying lipid-lowering intensification translates into worse health and economic outcomes than early and intense lipid lowering for statin-treated individuals with uncontrolled low-density lipoprotein cholesterol and no previous cardiovascular disease.
Abstract
Objectives
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.
Methods
A lifetime Markov cohort model (n = 1000) estimating the impact on coronary heart
disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients
with uncontrolled LDL-C, at moderate to high risk of CHD with no delay or after a
5-year delay, compared with standard of care (no intensification), starting at age
40 years. 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 randomization data. Outcomes included CHD events, quality-adjusted
life-years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness
ratios (ICERs). All outcomes were discounted annually by 5%.
Results
Over the lifetime horizon, compared with standard of care, achieving LDL-C control
with no delay with high-intensity statins prevented 29 CHD events and yielded 30 extra
QALYs (ICERs AU$13 205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20 270/QALY)
with a 5-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 5-year delay.
Conclusions
Delaying attainment of LDL-C goals translates into lost therapeutic benefit and a
waste of resources. Urgent policies are needed to improve LDL-C goal attainment in
statin-treated patients.
Keywords
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Article info
Publication history
Published online: November 24, 2022
Accepted:
November 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
