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Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults
Ciaran N Kohli-Lynch1, Brandon K Bellows2, Yiyi Zhang2
1Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA; Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA; Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
Insights
High LDL-C in young adults increases future heart disease risk. Early statin treatment for LDL-C levels of 130 mg/dL is cost-effective for men and women, preventing cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Health Economics
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) in young adulthood (18-39 years) is a significant risk factor for developing atherosclerotic cardiovascular disease (ASCVD) later in life.
- The majority of young adults with high LDL-C do not currently receive lipid-lowering therapies, representing a gap in preventive care.
Purpose of the Study:
- To determine the prevalence of elevated LDL-C among U.S. young adults free of ASCVD.
- To evaluate the cost-effectiveness of initiating lipid-lowering strategies in young adulthood compared to standard care for managing high LDL-C.
Main Methods:
- Prevalence of elevated LDL-C was analyzed using data from the U.S. National Health and Nutrition Examination Survey.
- The CVD Policy Model was employed to project lifetime quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratios (ICERs) for various lipid-lowering strategies.
- Simulations compared standard care (statin treatment initiated at age ≥40 based on risk factors) with early interventions (moderate-intensity statins or intensive lifestyle changes) for young adults with LDL-C ≥160 mg/dL or ≥130 mg/dL.
Main Results:
- Approximately 27% of ASCVD-free young adults have LDL-C ≥130 mg/dL, and 9% have LDL-C ≥160 mg/dL.
- Early lipid-lowering interventions in young adults were projected to prevent lifetime ASCVD events and improve QALYs compared to standard care.
- The ICER for statins in young adult men with LDL-C ≥130 mg/dL was $31,000/QALY, and for young adult women, it was $106,000/QALY. Intensive lifestyle interventions proved less effective and more costly than statins.
Conclusions:
- Initiating statin therapy for LDL-C levels of 130 mg/dL or higher in young adulthood is highly cost-effective for men and intermediately cost-effective for women.
- These findings support the consideration of early lipid-lowering interventions to mitigate long-term cardiovascular risk in young adults.
Background:
Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood (aged 18-39 years) is associated with atherosclerotic cardiovascular disease (ASCVD) later in life. Most young adults with elevated LDL-C do not currently receive lipid-lowering treatment.
Objectives:
This study aimed to estimate the prevalence of elevated LDL-C in ASCVD-free U.S. young adults and the cost-effectiveness of lipid-lowering strategies for raised LDL-C in young adulthood compared with standard care.
Methods:
The prevalence of raised LDL-C was examined in the U.S. National Health and Nutrition Examination Survey. The CVD Policy Model projected lifetime quality-adjusted life years (QALYs), health care costs, and incremental cost-effectiveness ratios (ICERs) for lipid-lowering strategies. Standard care was statin treatment for adults aged ≥40 years based on LDL-C, ASCVD risk, or diabetes plus young adults with LDL-C ≥190 mg/dL. Lipid lowering incremental to standard care with moderate-intensity statins or intensive lifestyle interventions was simulated starting when young adult LDL-C was either ≥160 mg/dL or ≥130 mg/dL.
Results:
Approximately 27% of ASCVD-free young adults have LDL-C of ≥130 mg/dL, and 9% have LDL-C of ≥160 mg/dL. The model projected that young adult lipid lowering with statins or lifestyle interventions would prevent lifetime ASCVD events and increase QALYs compared with standard care. ICERs were US$31,000/QALY for statins in young adult men with LDL-C of ≥130 mg/dL and US$106,000/QALY for statins in young adult women with LDL-C of ≥130 mg/dL. Intensive lifestyle intervention was more costly and less effective than statin therapy.
Conclusions:
Statin treatment for LDL-C of ≥130 mg/dL is highly cost-effective in young adult men and intermediately cost-effective in young adult women.
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