Table 1.
Simulation parameters
| Parameter | Base case | Distribution for PSA | Lower Bound | Upper Bound | Source |
|---|---|---|---|---|---|
| RR per 1.0 mmol/L time-weighted average LDL-C reduction | |||||
| CHD | 0.740 | Beta | 0.710 | 0.780 | (13) |
| Stroke | 0.900 | Beta | 0.810 | 0.990 | (13) |
| RR per 1.0 mmol/L LDL-C reduction from statin therapy in adulthood | |||||
| CHD | 0.760 | Beta | 0.730 | 0.790 | (5) |
| Stroke | 0.850 | Beta | 0.800 | 0.890 | (5) |
| Statin LDL-C reduction (% change from baseline) | |||||
| Moderate-intensity | 29.0 | Beta | 14.0 | 38.0 | (17) |
| High-intensity | 43.0 | Beta | 39.0 | 46.0 | (17) |
| Statin-related adverse events | |||||
| Statin-induced diabetes, absolute annual risk increase (%) | 0.500 | Log-normal | 0.000 | 1.00 | (43) |
| Pill-taking disutility | 0.002 | Beta | 0.000 | 0.004 | (23) |
| Probability minor adverse event (%) | 4.7 | Beta | 0.0 | 9.4 | (23) |
| Probability major adverse event (%) | 0.006 | Beta | 0.000 | 0.012 | (23) |
| Cost minor adverse event ($) | 178.53 | Gamma | 133.90 | 223.16 | (23) |
| Cost major adverse event ($) | 7,033.00 | Gamma | 5,274.75 | 8,791.25 | (23) |
| Statin treatment adherence (%) | |||||
| Year 1 | 67.0 | Beta | 50.0 | 84.0 | (21) |
| Year 2 | 53.0 | Beta | 40.0 | 66.0 | (21) |
| Subsequent Years | 50.0 | Beta | 38.0 | 63.0 | (21) |
| Young adult intensive lifestyle intervention effects | |||||
| LDL-C reduction (mmol/L) | 0.05 | Beta | 0.00 | 0.11 | (18) |
| SBP reduction (mm Hg) | 1.80 | Beta | 0.89 | 2.21 | (18) |
| Relative risk incident diabetes | 0.67 | Beta | 0.51 | 0.87 | (18) |
| Duration of effect (years) | 5.00 | n/a | 2.00 | 8.00 | (18) |
| Annual intervention costs ($) | |||||
| Moderate-intensity (median; Medical Expenditure Panel Survey) | 102.52 | Gamma | 41.18 | 163.85 | (44) |
| High-intensity (median; Medical Expenditure Panel Survey) | 151.34 | Gamma | 65.70 | 236.98 | (44) |
| Statin dispensing fees | 30.00 | Gamma | 0.00 | 60.00 | Assumption |
| Group-based intensive lifestyle change intervention in primary care setting | 512.83 | Gamma | 384.63 | 641.04 | (26) |
| Checkup and screening visit costs ($ per visit) | |||||
| Checkup visit, on treatment | 81.83 | Gamma | 59.96 | 99.93 | (45) |
| Screening visit, no treatment | 81.83 | Gamma | 59.96 | 99.93 | (45) |
| Cardiovascular prevention behavioral visit (15 minutes) | 33.07 | Gamma | 24.23 | 40.38 | (45) |
| Other costs ($) | |||||
| Lipid panel test | 23.92 | Gamma | 17.94 | 29.89 | (46) |
| Liver panel test | 1.47 | Gamma | 1.10 | 1.84 | (46) |
| Weighted statin-induced diabetes cost | 9.75 | Gamma | 7.32 | 12.19 | (46) |
| Office visit frequency | |||||
| Years between screening visits | 5.00 | n/a | 4.00 | 6.00 | (16) |
| Primary care check-up while on statin treatment (years) | 1.25 | Gamma | 0.00 | 3.00 | (16) |
| Behavioral visits in treatment years 2 to 5 | 4.00 | Gamma | 1.00 | 7.00 | Assumption |
| Discount rate (%) | |||||
| Health | 3.0 | n/a | 0.0 | 6.0 | (29) |
| Costs | 3.0 | n/a | 0.0 | 6.0 | (29) |
LDL-C – low-density lipoprotein cholesterol; PSA – probabilistic sensitivity analysis; RR – relative risk; SBP – Systolic blood pressure
Footnote: This table contains a list of the parameters employed to simulate cholesterol screening, statin therapy, and lifestyle interventions in our analysis. Probabilistic distributions are provided, which were used to stochastically sample these parameters. Lower and upper bounds are provided, which detail ranges employed in one-way sensitivity analyses.