Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States

Abstract

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.

Figure 1

Sensitivity analysis of magnitude of statin associated disability adjusted life-year reduction that would be needed to offset the cardiovascular benefit. The value of the statin-associated disability adjusted life-year reduction at which the lines cross the x-axis is the magnitude needed to offset the cardiovascular benefit and result in no net disability adjusted life-years gained.