AIM: Depending on cost, statin guideline adherence could prevent heart disease

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The Adult Treatment Panel III guidelines are relatively cost-effective and would have a large public health impact if implemented fully in the U.S.; however, alternate strategies may be preferred, depending on the cost of statins and how much society is willing to pay for better health outcomes, according to research published in the Feb. 17 issue of the Annals of Internal Medicine.

The ATP III developed recommendations on when and how to treat high cholesterol with statins. They recommended statins for patients with higher cholesterol and more risk factors for coronary heart disease (CHD). Because of "poor adherence to ATP III guidelines," researchers sought to determine the strategy's cost, complexity and efficiency.

Mark J. Pletcher, MD, from the University of California, San Francisco and colleagues used the CHD Policy Model to target the U.S. population ages 35 to 85 in the time horizon of 2010 through 2040.

Investigators found that full adherence to ATP III primaryprevention guidelines would require starting (9.7 million) orintensifying (1.4 million) statin therapy for 11.1 million adultsand would prevent 20,000 MIs and 10,000CHD deaths per year at an annual net cost of $3.6 billion [$42,000/quality-adjusted life year (QALY)]if low-intensity statins cost $2.11 per pill.

They found that the ATP III guidelineswould be preferred over alternative strategies if society iswilling to pay $50,000/QALY and statins cost $1.54 to $2.21per pill. At higher statin costs, ATP III is not cost-effective;at lower costs, more liberal statin-prescribing strategies wouldbe preferred; and at costs less than $0.10 per pill, treatingall persons with low-density lipoprotein cholesterol levelsgreater than 3.4 mmol/L (>130 mg/dL) would yield net costsavings, the authors wrote.

The researchers said they results are sensitive to theassumptions that LDL cholesterol becomes less important as arisk factor with increasing age and that little disutility resultsfrom taking a pill every day.

Pletcher and colleagues concluded that the optimumpolicies for lipid lowering with statins are highly dependenton statin costs.