Table 3.
Incremental cost-effectiveness outcomes for lipid-lowering strategies in U.S. young adult men and young adult women
| Policy | ASCVD Events Prevented (95% UI) | Discounted QALYs (95% UI) | Discounted total costs, thousands of 2020 $US (95% UI) | Incremental cost-effectiveness ratio ($/QALY) |
|---|---|---|---|---|
| Women | ||||
| Standard care* | Reference | Reference | Reference | Reference |
| Standard care + young adult LDL-C ≥160 mg/dL (lifestyle)** | 32 (11–57) | 130 (55–225) | 13,800 (12,500–22,100) | Strictly Dominated |
| Standard care + young adult LDL-C ≥160 mg/dL (statins) | 86 (38–150) | 167 (2–424) | 8,600 (2,580–17,100) | 51,500 |
| Standard care + young adult LDL-C ≥130 mg/dL (lifestyle)** | 98 (43–165) | 510 (256–778) | 77,800 (39,300–131,000) | Strictly Dominated |
| Standard care + young adult LDL-C ≥130 mg/dL (statins) | 412 (214–688) | 601 (−174–1,590) | 54,500 (24,800–101,000) | 106,000 |
| Men | ||||
| Standard care* | Reference | Reference | Reference | Reference |
| Standard care + young adult LDL-C ≥160 mg/dL (lifestyle)** | 164 (90–244) | 384 (215–639) | 25,200 (13,400–43,500) | Strictly Dominated |
| Standard care + young adult LDL-C ≥160 mg/dL (statins) | 491 (275–827) | 817 (274–1,630) | 10,800 (−3,190–28,300) | 13,200 |
| Standard care + young adult LDL-C ≥130 mg/dL (lifestyle)** | 405 (255–594) | 1,040 (643–1,530) | 101,000 (53,000–179,000) | Strictly Dominated |
| Standard care + young adult LDL-C ≥130 mg/dL (statins) | 1,530 (820–2,470) | 2,250 (592–4,470) | 55,200 (9,000–121,000) | 31,000 |
Mean and 95% uncertainty interval (95% UI; i.e., the 2.5th to 97.5th percentile interval of the means) were calculated for model outcomes from 100 probabilistic simulations in which model inputs were sampled from pre-specified distributions.
Treatment according to ACC/AHA 2018 guidelines; “standard care” strategy consisted of later life (age ≥40 years) statin treatment if clinical ASCVD, diabetes, LDL-C ≥190 mg/dl, or ten-year ASCVD risk ≥7.5% and young adult statin treatment if LDL-C ≥190 mg/dl.
Individuals with LDL-C ≥190 mg/dL also received moderate-intensity statins
LDL-C – low-density lipoprotein cholesterol; UI = uncertainty interval based on probabilistic analysis. To convert LDL-C from mg/dL to mmol/L, divide by 38.67.