Table 2.
One-Way Sensitivity Analyses
| Parameter (base-case assumption) | Preferred strategy for a 55-year old woman with high cholesterol* if society is willing to pay up to $50,000/QALY |
|
|---|---|---|
| Favorable statin assumptions: $0.13/pill and no disutility† | Less favorable statin assumptions: $1.00/pill and disutility = .00384† | |
| Base-case | Treat All | Treat if CAC>0 |
| Statin price ($0.13 or $1.00/pill)† | ||
| - $0.10/pill | Treat All | Treat All |
| - $0.13 | Treat All† | Treat All |
| - $0.50 | Treat All | Treat All |
| - $1.00 | Treat All | Treat if CAC>0† |
| - $2.00 | Treat if CAC>0 | Treat if CAC>0 |
| - $4.00 | Treat None | Treat None |
| Statin disutility (0 or .00384)† | ||
| -0 | Treat All† | Treat All |
| - .001 | Treat All | Treat All |
| - .00384 | Treat All | Treat if CAC>0† |
| - .0075 | Treat All | Treat if CAC>0 |
| - .01 | Treat if CAC>0 | Treat if CAC>0 |
| - .015 | Treat if CAC>0 | Treat None |
| - .02 | Treat None | Treat None |
| Statin myopathy rate, per person-year (.001) | ||
| - .005 | Treat All | Treat if CAC>0 |
| - .01 | Treat All | Treat if CAC>0 |
| - .05 | Treat All | Treat if CAC>0 |
| Statin discontinuation (31%) | ||
| - 0% | Treat All | Treat if CAC>0 |
| - 50% | Treat All | Treat if CAC>0 |
| - 75% | Treat All | Treat All |
| Statin efficacy (0% reduction)‡ | ||
| 25% increase | Treat All | Treat if CAC>0 |
| 25% reduction | Treat All | Treat if CAC>0 |
| 50% reduction | Treat None | Treat None |
| 75% reduction | Treat None | Treat None |
| CAC scan direct cost ($114.37) | ||
| - $100 | Treat All | Treat if CAC>0 |
| - $250 | Treat All | Treat if CAC>0 |
| - $400 | Treat All | Treat if CAC>0 |
| - $600 | Treat All | Treat All |
| Average cost of working up incidental findings from CAC scan ($40.19) | ||
| - $0 | Treat All | Treat if CAC>0 |
| - $100 | Treat All | Treat if CAC>0 |
| - $250 | Treat All | Treat if CAC>0 |
| CAC scan relative risks (0% reduction from Detrano 200811)‡ | ||
| 10% reduction | Treat All | Treat if CAC>0 |
| 25% reduction | Treat All | Treat if CAC>0 |
| 50% reduction | Treat All | Treat All |
| 75% reduction | Treat All | Treat All |
| CAC scan radiation exposure (2.3 mSv) | ||
| 1 mSv | Treat All | Treat if CAC>0 |
| 5 mSv | Treat All | Treat if CAC>0 |
| 10.5 mSv15 | Treat All | Treat if CAC>0 |
| All-cause mortality relative risks after CVD events (0% reduction)‡ | ||
| 25% reduction | Treat All | Treat if CAC>0 |
| 50% reduction | Treat All | Treat if CAC>0 |
| 75% reduction | Treat All | Treat if CAC>0 |
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.
Indicates base-case scenarios. Statin price and disutility were varied in one-way sensitivity analyses within each scenario to show the independent contribution of each factor. For one-way analyses where a different parameter is varied, we show results for both favorable and unfavorable statin assumption scenarios. 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 = .00384, equivalent to 2 weeks of perfect health traded away to avoid 10 years on statins.
Statin efficacy (relative risk reductions for myocardial infarction, angina, CHD death, and stroke), CAC scan relative risks (for CHD events based on the CAC score), and all cause mortality relative risks after CVD events (risk of death multipliers in post-CHD and stroke event states) were varied from the base-case assumptions (see Supplemental Table 1) simultaneously by the % reduction shown, after conversion to the log scale. Statin efficacy relative risks were also increased in sensitivity analyses given that larger relative risks were observed for lower risk participants in our meta-analysis source for statin efficacy1.
CHD – Coronary heart disease; CVD events – Cardiovascular disease events, including; CAC – Coronary artery calcium; Treat if CAC>X – Test for CAC, and treat with statins if the CAC score is over X.