1. A computer simulation shows that the use of statins for primary prevention in those older than 75 years of age may reduce coronary heart disease-related morbidity and mortality.
2. The net cost benefit of all primary prevention strategies in the elderly were highly dependent on the assumptions made regarding functional limitation and cognitive impairment due to statin use.
Evidence Rating Level: 2 (Good)
Study Rundown: The guidelines for the use of statins, a class of cholesterol-lowering drugs, in people over 75 years old are inconsistent and little is known about their effectiveness in primary prevention. In this study, a computer model was employed to study the effect of statin-based primary prevention strategies in 75 to 94 year-old Americans without cardiovascular disease (CVD) over 10 years, as compared to secondary prevention in people with existing CVD. Over the next 10 years, the model predicted that these elderly Americans will experience 2.5 million myocardial infarctions, 3.1 million coronary heart disease-related deaths, and accumulate $881 billion in CVD-related costs. The simulation showed that statins for primary prevention at three different LDL-cholesterol thresholds could avoid many of the MIs and CHD-related deaths, and may be cost-saving in some demographic subgroups when compared to secondary prevention. However, the cost-effectiveness of the primary prevention strategies was highly sensitive to small changes in the assumptions regarding adverse effect profile of statins. This was the major limitation of the study, as only the two most well-documented adverse effects were incorporated into the model, which may underestimate the overall burden of functional limitation due to statins.
In-Depth [computer simulation]: This study modeled the disease burden and cost-benefit of statins in 75 to 94 year-old individuals in the United States using the Cardiovascular Disease Policy Model. The effects of statins were based on 3 estimates using the PROSPER randomized trial results, and the Consumer Price Index was used to inflate costs to 2014 costs. Furthermore, drug costs were derived from the National Average Drug Acquisition Cost (NADAC) database, and the average of multiple studies was used to determine the prevalence of mild cognitive impairment and functional limitation from myopathy due to statin use. In this simulation, giving statins to all adults aged 75 to 94 with a history of cardiovascular disease (i.e., secondary prevention) who weren’t already using a statin prevented 53,000 MIs, avoided 85,000 CHD-deaths, gained 269,000 disability-adjusted life years (DALYs) and decreased societal costs by $14 billion. The primary prevention strategies tested were giving every person in the age group statins, only every person with diabetes, and only people with LDL-C levels of ≥4.91, ≥4.14 and ≥3.36.
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