Statin Therapy Decision Tool

(Lee KK, Cipriano LE, Owens DK, Go AS, Hlatky MA. Cost-effectiveness of using high sensitivity C-reactive protein to identify intermediate and low cardiovascular risk individuals for statin therapy. Circulation. 2010 Oct 12. In Press.)

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Purpose

The online calculator seeks to help decision-makers identify the optimal cost effective policy for hs-CRP screening and statin therapy in intermediate and low risk adults with an LDL cholesterol less than 130 mg/dl.

Methods

The online calculator is based on a published decision-analytic Markov model (http://weblink to article). This model includes all costs, regardless of who accrues them (patients or their health insurer), and projects the life-time benefits, harms, and costs of each strategy. The "optimal strategy" provides the greatest benefit with an incremental cost effectiveness ratio compared to the next best strategy less than the maximum willingness to pay threshold of $50,000 per quality-adjusted life-year (QALY) gained.

Strategies Compared

• Current Adult Treatment Panel III guidelines for lipid therapy, without hs-CRP testing
• Measure hs-CRP levels in those without an indication for statin treatment by current guidelines and begin treatment for individuals with an hs-CRP of 2.0 or more
• Initiate statin therapy without hs-CRP testing based on the patient's age and other risk factors.

Model inputs

Age: 40, 45, 50, 55, 60, 65, or 70
Gender: Male or female
Risk factors: None, hypertension only, smoking and hypertension

Statin Effect by hs-CRP level

1. 'Equivalent' = statins reduce the relative risk of CVD equally for all hs-CRP levels
2. "Differential" = statins reduce the relative risk of CVD only for high hs-CRP levels

Quality of life decrement from statin therapy

1. "No loss of quality of life" - healthy individuals on a statin have no change in quality of life
2. "1% reduction in quality of life" - healthy individuals on a statin have 1% lower quality of life
3. "3% reduction in quality of life" - healthy individuals on a statin have 3% lower quality of life

Model assumptions

Total cholesterol: 186 mg/dL
LDL cholesterol: 108 mg/dL
Statin cost: $1.10 per day
No increased risk of diabetes from statin treatment

Interpreting the model result

The calculator identifies the policy that is optimally cost effective from the societal perspective for a cohort of patients with the selected characteristics at a willingness to pay threshold of $50,000 per QALY-gained. The calculator does not identify the optimal strategy for an individual patient.