The Potential Effects of Implementing the 2013 ACC/AHA Cholesterol Guidelines on the Use of Statins in a Large Health Maintenance Organization in Israel

Abstract

BackgroundThe 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for the management of blood cholesterol identify candidates for statin therapy to prevent atherosclerotic cardiovascular disease (ASCVD). ObjectiveThe objective was to estimate the effect of adopting the ACC/AHA guidelines in Maccabi Healthcare Services (MHS), a large health maintenance organization in Israel. MethodsThis population-based study, conducted in June 2014, included all MHS members 40 years or older. We searched the computerized database of MHS to determine the number of members currently on statins, calculated the number of additional members newly eligible for statin treatment according to the new guidelines, and estimated the cost of implementing the guidelines in MHS. ResultsIn June 2014, there were 798,076 MHS members 40 years or older. Of the 725,784 members included, 30% were receiving statin treatment at baseline. Adopting the new guidelines would increase the proportion of statin-treated members to 48% (58% and 39% among men and women, respectively). Newly eligible members were more likely to be 55 to 69 years old, men, and have a predicted 10-year ASCVD risk of 7.5% or more. The calculated incremental annual cost for medications is 54 million new Israeli shekels (US $13.5 million). The cost per cardiovascular event prevented is estimated at 82,000 new Israeli shekels (US $20,500). ConclusionsAdopting the ACC/AHA 2013 cholesterol guidelines would increase the number of MHS members 40 years or older eligible for statin therapy by 60%, with the increase mainly in primary prevention due to the predicted 10-year ASCVD risk.