Table 3.
Individual Lifetime Clinical Outcomes, QALYs, Costs, and ICERs for Generic Statin Cost ($68/y) Scenario
| ACC/AHA ASCVD Risk Threshold, % |
Adults Statin Eligible, % |
Statin-Induced Diabetes Casesa |
CVD Eventsa,b | Life Expectancy, y | QALYsc | Costs, 2013 US $c |
ICER (US $/QALY) |
|---|---|---|---|---|---|---|---|
| No ASCVD threshold |
8 | 0.0019 | 0.4493 | 81.237 | 17.276 | 20 695 | 1 [Reference] |
| ≥30.0 | 34 | 0.0030 | 0.4437 | 81.265 | 17.287 | 20 808 | Extended dominanced |
| ≥20.0 | 36 | 0.0039 | 0.4405 | 81.293 | 17.299 | 20 878 | Extended dominanced |
| ≥15.0 | 39 | 0.0045 | 0.4384 | 81.315 | 17.309 | 20 942 | 7400/QALY |
| ≥10.0 | 44 | 0.0055 | 0.4365 | 81.341 | 17.320 | 21 073 | 12 000/QALY |
| ≥7.5e | 48 | 0.0062 | 0.4353 | 81.356 | 17.327 | 21 169 | 15 000/QALY |
| ≥5.0 | 57 | 0.0072 | 0.4344 | 81.371 | 17.333 | 21 330 | 27 000/QALY |
| ≥4.0 | 61 | 0.0076 | 0.4340 | 81.377 | 17.335 | 21 406 | 38 000/QALY |
| ≥3.0 | 67 | 0.0080 | 0.4337 | 81.382 | 17.336 | 21 514 | 72 000/QALY |
| ≥2.0 | 75 | 0.0085 | 0.4334 | 81.386 | 17.337 | 21 651 | 460 000/QALY |
| ≥1.0 | 87 | 0.0091 | 0.4333 | 81.389 | 17.336 | 21 819 | Strong dominancef |
| Treat all adults with statins |
100 | 0.0097 | 0.4332 | 81.391 | 17.334 | 21 986 | Strong dominancef |
Abbreviations: ACC/AHA, The American College of Cardiology and the American Heart Association; ASCVD, atherosclerotic cardiovascular disease; ICER, incremental cost-effectiveness ratio; QALYs, quality-adjusted life-years.
Values indicate proportion of all adults that experience this outcome at some point in their lifetime. Results for statin-induced diabetes cases and CVD events correspond to the average lifetime risk of experiencing each of these outcomes for individuals in the model population.
Defined as nonfatal or fatal: myocardial infarction, angina, cardiac arrest, or stroke.
Discounted at 3%.
Extended dominance: other, more effective strategies have lower cost-effectiveness ratios than this strategy.
ASCVD risk threshold used in 2013 ACC/AHA guidelines.
Dominated: other strategies are less costly and more effective than this strategy. Based on recommendations, strategies that are dominated by either mechanism (strong dominance or extended dominance) are eliminated from further consideration in a cost-effectiveness analysis.