Table 2.
Impact and Efficiency Estimates for Risk‐Targeted Versus Benefit‐Targeted Prescribing of Moderate‐Intensity Statins
| Targeting Strategy Treatment Threshold | Impact | Efficiency | |
|---|---|---|---|
| Proportion of ASCVD Events Preventable % (95% CIa) | Average NNT10 (95% CIa) | Maximum NNT10 b | |
| Risk‐based prescribing | |||
| Treat all | 8.3 (7.2–9.5) | 48.3 (45.1–52.0) | 2100 |
| Treat if baseline riskc >3% | 6.8 (5.7–7.9) | 29.1 (27.9–30.3) | 180 |
| Treat if baseline risk >5% | 5.6 (4.7–6.6) | 24.6 (23.5–25.8) | 180 |
| Treat if baseline risk >7.5% | 4.4 (3.7–5.2) | 21.2 (20.4–22.0) | 54 |
| Treat if baseline risk >10% | 3.2 (2.6–3.7) | 19.1 (18.3–19.9) | 39 |
| Treat if baseline risk >15% | 1.6 (1.2–2.0) | 16.2 (15.4–16.9) | 39 |
| Benefit‐based prescribing | |||
| Treat all | 8.3 (7.2–9.5) | 48.3 (45.1–52.0) | 2100 |
| Treat if expected ARRc >1.0% | 7.5 (6.4–8.7) | 33.6 (31.9–35.4) | 100 |
| Treat if expected ARR >1.5% | 6.9 (5.8–8.0) | 29.2 (27.8–30.7) | 66.5 |
| Treat if expected ARR >2.3% | 5.7 (4.8–6.7) | 24.2 (23.1–25.4) | 43.5 |
| Treat if expected ARR >3.0% | 4.8 (4.0–5.7) | 21.6 (21.0–22.2) | 33.3 |
| Treat if expected ARR >4.0% | 3.3 (2.7–4.0) | 18.6 (18.0–19.1) | 24.9 |
| Treat if expected ARR >5.0% | 1.9 (1.5–2.3) | 15.6 (15.0–16.2) | 19.9 |
ASCVD indicates atherosclerotic cardiovascular disease; CIs, confidence intervals; NNT10, number need to treat over 10 years to prevent 1 event.
CIs presented here are the 2.5th and 97.5th percentiles of the distribution of estimates derived from analyzing bootstrapped samples accounting for the complex National Health and Nutrition Examination Survey survey design and multiple imputation procedure.
We do not present confidence intervals for maximum NNT10 because this value is entirely dependent (defined by) a single outlier value in the data set and does not represent a statistical estimate.
Atherosclerotic cardiovascular disease (ASCVD) risk was estimated using the algorithm described in the 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk2 for persons without pre‐existing cardiovascular disease, or an alternate Framingham‐based risk equation6, 7 with extrapolation to 10 years, for persons with and without pre‐existing cardiovascular disease, respectively.