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Implications of New Cholesterol Treatment Guidelines on Statin Utilization, Intensity, and Costs in Active Duty
Michael S Cahill1, Rebecca M Seifried2, Julia H Cheringal1
1Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
Insights
The 2013 cholesterol guidelines may not increase statin eligibility in active duty members but could raise treatment intensity and costs. This impacts cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Economics
Background:
- The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines expanded statin therapy indications for primary cardiovascular disease prevention.
- These updated guidelines potentially alter treatment and cost implications for specific populations.
Purpose of the Study:
- To assess the treatment and cost implications of the 2013 ACC/AHA cholesterol guidelines.
- To compare ACC/AHA guidelines with the Third Adult Treatment Panel (ATP III) guidelines in active duty service members.
Main Methods:
- Utilized the Armed Forces Health Longitudinal Technology Application (AHLTA) military electronic medical record system.
- Randomly selected 1,000 active duty individuals aged 40+ to review lipid profiles and identify atherosclerotic cardiovascular disease risk factors.
Main Results:
- No significant difference in statin eligibility between ACC/AHA and ATP III guidelines in this cohort.
- ACC/AHA guidelines increased mean statin dose (25 to 36 mg) and high-intensity statin eligibility (6% to 11%).
- Estimated yearly statin costs increased from $40,197 to $52,527 per 1,000 patient-years.
Conclusions:
- In a low-risk, active duty population over 40, the 2013 ACC/AHA cholesterol guidelines may not substantially increase the number of individuals eligible for statins.
- However, these guidelines are associated with increased statin treatment intensity and higher associated healthcare costs.
Background:
The recommendations in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol guidelines expanded the indications and level of intensity of statin therapy for the primary prevention of cardiovascular disease. We assessed the treatment and cost implications of theseguidelines within a cohort of active duty service members.
Methods:
Using the military electronic medical record system, the Armed Forces Health Longitudinal Technology Application, we randomly selected 1,000 active duty persons aged 40 yr or older and reviewed their lipid profiles and medical records to identify risk factors for atherosclerotic cardiovascular disease. We compared the recommended cholesterol treatment under the new ACC/AHA guidelines versus the Third Adult Treatment Panel of the National Cholesterol Education Program.
Findings:
The mean age was 49 ± 7 yr, 36% were female, 22% were on baseline statin therapy (4% high intensity), and 13% were not at Third Adult Treatment Panel cholesterol goal. There was no difference in the proportion eligible for statin therapy between ACC/AHA and Third Adult Treatment Panel guidelines. Statin treatment under the ACC/AHA guideline resulted in a mean statin dose increase from 25 ± 20 mg to 36 ± 25 mg (p < 0.001) with an increase in those eligible for high-intensity statin therapy, 6% to 11% (p < 0.001). These changes translated to higher estimated yearly statin acquisition costs, $40,197 versus $52,527 per 1,000 patient-years of treatment (p < 0.001).
Discussion:
Within a low-risk active duty population over 40 yr, application of the 2013 ACC/AHA cholesterol treatment guidelines may not significantly increase those eligible for statins, but may increase statin treatment intensity and costs.
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