Table 2.
Model Parameters
| Parameter | Base-Case (range) | Distribution | References |
|---|---|---|---|
| LDL-P relative risk (per SD) | 1.40 (1.12–1.75) | Log normal | Melander et al. JACC 2015 [8] |
| Fraction of CABG in revascularization | 0.2 (±20%) | β | Ohsfeldt et al. J Med Econ 2010 [35] |
| Fraction of fatal MI among MI | 0.125 (±20%) | β | Choudhry et al. JACC 2011 [36] |
| Fraction of fatal stroke among stroke | 0.132 (±20%) | β | Choudhry et al. JACC 2011 [36] |
| Fraction discontinuing statin therapya | 0.254 (0–0.444) | β | Pletcher et al. CircCQO 2014 [31] |
| Effect of Interventions | |||
| High-intensity statin | |||
| MI | 0.46 (0.30–0.70) | Log normal | Choudhry et al. JACC 2011 [36], Ridker et al. NEJM 2008 [11] |
| Revascularization | 0.54 (0.41–0.72) | Log normal | Choudhry et al. JACC 2011 [36], Ridker et al. NEJM 2008 [11] |
| Stroke | 0.52 (0.34–0.79) | Log normal | Choudhry et al. JACC 2011 [36], Ridker et al. NEJM 2008 [11] |
| Moderate-intensity statin | |||
| Coronary Artery Disease | 0.75 (0.71–0.78) | Log normal | Pandya et al. JAMA 2015 [21] |
| Stroke | 0.83 (0.76–0.87) | Log normal | Pandya et al. JAMA 2015 [21] |
| State utilities | |||
| Disease free off statins | 1 | unchanged | Assumption |
| Disease free taking statins | 0.998 (0.991–1.0) | β | Pandya et al. JAMA 2015 [21] |
| Post MI | 0.778 (0.575–0.843) | β | Sullivan et al. Med Decis Making 2006 [22] |
| Post Stroke | 0.768 (0.463–0.816) | β | Sullivan et al. Med Decis Making 2006 [22] |
| Post PCI or CABG | 0.768 (0.517–0.827) | β | Sullivan et al. Med Decis Making 2006 [22] |
| Multiple CVDb | 0.605 (±20%) | β | Calculated from Sullivan et al. Med Decis Making 2006 [22] |
| Diabetes | 0.800 (0.708–0.844) | β | Sullivan et al. Med Decis Making 2006 [22] |
| Mild adverse events (disutility) | 0.005 (±20%) | β | Lee et al. Circulation 2010 [32] |
| Severe adverse events (disutility) | 0.038 (±20%) | β | Lee et al. Circulation 2010 [32] |
| Costs (2014 US dollars) | |||
| LDL-P test | 42.29 (±20%) | γ | CMS fee schedule [37] |
| Nonfatal MI (1st year) | 69,819 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| Fatal MI | 19,373 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| Nonfatal stroke (1st year) | 23,021 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| Fatal stroke | 11,951 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| CABG (1st year) | 41,388 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| PCI (1st year) | 38,998 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| Diabetes (diagnosis) | 138.18 (±20%) | γ | Choudhry et al. JACC 2011 [36] |
| Severe adverse events | 7,852 (±20%) | γ | Lee et al. Circulation 2010 [32] |
| Mild adverse events | 199.32 (±20%) | γ | Lee et al. Circulation 2010 [32] |
| Low/Moderate-intensity statin therapy (annual) | 48.00 (±20%) | γ | www.healthwarehouse.com [39] |
| High-intensity statin therapy (annual) | 91.00 (±20%) | www.healthwarehouse.com [39] | |
| MI (subsequent years, annual) | 507.83 (±20%) | γ | Choudhry et al. JACC 2011 [36] |
| CABG or PCI (subsequent years, annual) | 507.83 (±20%) | γ | Assumed to be equal to MI |
| Stroke (subsequent years, annual) | 20263.60 (±20%) | γ | Choudhry et al. JACC 2011 [36] |
| Multiple CVD state (subsequent years, annual) | 9968.34 (±20%) | γ | O’Sullivan et al. Pharmacoeconomics 2011 [38] |
| Diabetes (annual) | 2660.67 (±20%) | γ | Soni, AHRQ statistical brief #304. 2010 [40] |
aStatin discontinuation includes discontinuation due to adverse events
bMultiple CVD utility is assumed to be the utility of post-MI state squared