Abstract 232: Cost-effectiveness Analysis of Lipoprotein Subfraction Testing in Patients at Intermediate Risk of Cardiovascular Events

Abstract

Background: The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease (CVD) in Adults defined 4 patient groups who would benefit from statin therapy. For patients who are not classified into a statin benefit group, and have an estimated 10-year CVD risk between 5% and 7.5%, the guidelines suggest that additional risk factors may be considered to inform moderate-intensity statin treatment decisions. Low density lipoprotein concentration (LDL-P) has been shown to be associated with incident CVD events among patients with <7.5% 10-year risk after adjusting for established risk factors. Objectives: To assess the cost-effectiveness of using LDL-P for risk assessment as an aid in making statin treatment decisions in patients with an estimated 10-year CVD risk of 5% to 7.5%. Methods: We conducted a cost-effectiveness analysis using a Markov model that assessed patient healthcare costs and outcomes from a payer perspective over a 5 year time horizon. A usual care strategy was compared with an LDL-P test-and-treat strategy in a hypothetical intermediate risk population_those with an estimated 10-year CVD risk of 5% to 7.5%. The test-and-treat strategy entailed testing LDL-P levels in 10,000 patients and treating only those in the top decile of LDL-P _those who would be reclassified above estimated 7.5% 10-year risk_with a moderate-dose statin therapy. Future cost and utilities were derived from published literature and were discounted at 3% annually. Single- and multi-variable sensitivity analyses were conducted to investigate the effect of the base-case assumptions on the difference in costs and quality-adjusted life years (QALYs) between the two strategies. Results: Compared with a usual care strategy, LDL-P testing of 10,000 patients followed by moderate-intensity statin therapy of patients in the top decile of LDL-P resulted in 17 fewer patients with CVD events, cost savings of more than $300,000, and about 13 additional QALYs over a 5 year horizon. Conclusions: CVD risk assessment by LDL-P testing of patients with estimated 10-year CVD risk of 5% to 7.5%, who were not classified into a statin benefit group, may be an event-reducing and a cost-saving strategy compared with usual care.