Table 1.
Health outcomes and costs for statin prescribing strategies with and without coronary calcium screening
| Outcome | Outcome from applying the given strategy to a theoretical cohort of 10,000 55-year-old women with high cholesterol* | ||||
|---|---|---|---|---|---|
| Treat None | Treat if CAC>300 | Treat if CAC>100 | Treat if CAC>0 | Treat All | |
| Cost of CAC screening | $0 | $2.25 million | $2.25 million | $2.25 million | $0 |
| On statins at baseline, n | 0 | 100 | 400 | 2,500 | 10,000 |
| Total lifetime cost of statin therapy, $ | |||||
| - at $0.13/pill† | $1.12 million | $1.21 million | $1.40 million | $2.97 million | $9.02 million |
| - at $1.00/pill† | $3.46 million | $3.74 million | $4.36 million | $9.43 million | $28.91 million |
| Other healthcare costs, $ total | $1,395.8 million | $1,395.1 million | $1,394.5 million | $1,391.6 million | $1,387.9 million |
| Total costs, $ | |||||
| - at $0.13/pill† | $1,396.9 million | $1,398.5 million | $1,398.1 million | $1,396.9 million | $1,396.9 million |
| - at $1.00/pill† | $1,399.3 million | $1,401.1 million | $1,401.1 million | $1,403.3 million | $1,416.8 million |
| Total number of events | |||||
| Angina | 739 | 736 | 731 | 706 | 675 |
| Myocardial infarction | 549 | 548 | 545 | 533 | 517 |
| Stroke | 479 | 479 | 479 | 479 | 473 |
| Statin-induced myopathy | 0 | 1 | 3 | 17 | 70 |
| CT-induced cancer | 0 | 9 | 9 | 9 | 0 |
| Life-years | 249,564 | 249,563 | 249,649 | 250,065 | 250,672 |
| Quality-adjusted life-years | |||||
| - with no statin disutility† | 170,435 | 170,437 | 170,488 | 170,728 | 171,075 |
| - with .00384 statin disutility† | 170,435 | 170,433 | 170,477 | 170,664 | 170,836 |
| Incremental cost, QALY's and $/QALY | |||||
| With favorable statin assumptions† | |||||
| Compared with Treat None | |||||
| - Incremental costs, $ | Reference | + $1.6 million | + $1.2 million | − $0.07 million | − $0.04 million |
| - Incremental QALYs | Reference | + 2 | + 53 | + 292 | + 640 |
| - $/QALY | Reference | $990,000 | $22,000 | Cost-saving | Cost-saving |
| Compared with next cheaper non-dominated strategy | |||||
| - Incremental costs, $ | Dominated | Dominated | Dominated | Least costly | + $0.03 million |
| - Incremental QALYs | Dominated | Dominated | Dominated | Reference | + 347 |
| - $/QALY | Dominated | Dominated | Dominated | Reference | $100‡ |
| With less favorable statin assumptions† | |||||
| Compared with Treat None | |||||
| - Incremental costs, $ | Reference | + $1.8 million | + $1.8 million | + $4.0 million | + $17.5 million |
| - Incremental QALYs | Reference | − 2 | + 41 | + 229 | + 401 |
| - $/QALY | Reference | Dominated | $43,000 | $18,000 | $44,000 |
| Compared with next cheaper non-dominated strategy | |||||
| - Incremental costs, $ | Reference | Dominated | Dominated | + $4.0 million | + $13.5 million |
| - Incremental QALYs | Reference | Dominated | Dominated | + 229 | + 172 |
| - $/QALY | Reference | Dominated | Dominated | $18,000‡ | $78,000 |
The base-case clinical scenario is a 55-year-old woman with total cholesterol = 221 mg/dl, HDL cholesterol = 40 mg/dl, systolic blood pressure = 120 mmHg without medications who does not smoke or have diabetes.
In the favorable statin assumptions scenario, statins cost $0.13/pill and have no disutility. In the less favorable statin assumptions scenario, statins cost $1.00/pill and have disutility = 0.00384, equivalent to 2 weeks of perfect health traded away to avoid 10 years on statins. Note that total statin costs account for discontinuation after myopathy and addition of statin therapy in all strategies for secondary prevention dependent on state membership.
Preferred strategy under the given assumptions if society is willing to pay up to $50,000 per QALY
CAC – Coronary artery calcium; CT – Computed tomography; QALY – Quality-adjusted life-year; Treat All – Treat all persons with statins and do not test for CAC; Treat None – Do not treat with statins and do not test for CAC; Treat if CAC>X – Test for CAC, and treat with statins if the CAC score is over X.