Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults.
Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults.
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DOI：
10.1016/j.jacc.2021.08.065
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发表时间：
2021-11-16
影响因子：
24
通讯作者：
Moran AE
中科院分区：
文献类型：
--
作者：
Kohli-Lynch CN;Bellows BK;Zhang Y;Spring B;Kazi DS;Pletcher MJ;Vittinghoff E;Allen NB;Moran AE
青年期（18-39岁）低密度脂蛋白胆固醇（LDL-C）升高与生命后期动脉粥样硬化性心血管疾病（ASCVD）相关。大多数LDL-C升高的年轻人目前没有接受降脂治疗。我们的目的是评估无ascvd的美国年轻人LDL-C升高的患病率，以及与标准治疗相比，降脂策略对年轻人LDL-C升高的成本效益。在美国国家健康和营养检查调查中检查了LDL-C升高的流行程度。CVD政策模型预测了降脂策略的终生质量调整生命年（QALYs）、医疗成本和增量成本-效果比（ICERs）。标准治疗是年龄≥40岁、有LDL-C、ASCVD风险或糖尿病的成年人加上LDL-C≥190 mg/dL的年轻人接受他汀类药物治疗。从年轻人LDL-C≥160 mg/dL或≥130 mg/dL开始，模拟使用中等强度他汀类药物或强化生活方式干预的降脂增量标准治疗。约27%无ascvd的年轻人LDL-C≥130 mg/dL， 9% LDL-C≥160 mg/dL。该模型预测，与标准治疗相比，年轻人使用他汀类药物降脂或生活方式干预可以预防终生ASCVD事件，并增加QALYs。LDL-C≥130 mg/dL的年轻成年男性他汀类药物的ICERs为31,000美元/QALY， LDL-C≥130 mg/dL的年轻成年女性他汀类药物的ICERs为106,000美元/QALY。强化生活方式干预比他汀类药物治疗更昂贵，效果更差。他汀类药物治疗LDL-C≥130 mg/dL对年轻成年男性具有很高的成本效益，对年轻成年女性具有中等成本效益。青年期低密度脂蛋白胆固醇（LDL-C）升高与晚年动脉粥样硬化性心血管疾病（ASCVD）相关。大多数LDL-C升高的年轻人不接受降脂治疗。我们使用CVD政策模型来评估与标准治疗相比，使用中等强度的他汀类药物或强化的生活方式干预降低青年LDL-C的成本效益。他汀类药物治疗年轻成人LDL-C≥130 mg/dL，预计对男性具有高成本效益，对女性具有中等成本效益。与他汀类药物相比，强化生活方式干预在降低年轻人血脂方面成本更高，效果更差。
Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood (ages 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. We 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. 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), healthcare 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. Around 27% of ASCVD-free young adults have LDL-C ≥130 mg/dL, and 9% have LDL-C ≥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 $31,000/QALY for statins in young adult men with LDL-C ≥130 mg/dL, and $106,000/QALY for statins in young adult women with LDL-C ≥130 mg/dL. Intensive lifestyle intervention was more costly and less effective than statin therapy. Statin treatment for LDL-C ≥130 mg/dL is highly cost-effective in young adult men and intermediately cost-effective in young adult women. Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood is associated with atherosclerotic cardiovascular disease (ASCVD) later in life. Most young adults with elevated LDL-C do not receive lipid-lowering treatment. We used the CVD Policy Model to estimate cost-effectiveness of lipid lowering with moderate-intensity statins or intensive lifestyle interventions for raised LDL-C in young adulthood compared with standard care. Statin treatment for LDL-C ≥130 mg/dL in young adulthood was projected to be highly cost-effective in men and intermediately cost-effective in women. Intensive lifestyle interventions were more costly and less effective than statins for young adult lipid lowering.
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影响因子：
37.8
作者：
Navar-Boggan AM;Peterson ED;D'Agostino RB Sr;Neely B;Sniderman AD;Pencina MJ
通讯作者：
Pencina MJ
影响因子：
24
作者：
Anderson, Jeffrey L.;Heidenreich, Paul A.;Shaw, Leslee J.
通讯作者：
Shaw, Leslee J.
影响因子：
168.9
作者：
Mihaylova, B.;Emberson, J.;Blackwell, L.;Keech, A.;Simes, J.;Barnes, E. H.;Voysey, M.;Gray, A.;Collins, R.;Baigent, C.;de Lemos, J.;Braunwald, E.;Blazing, M.;Murphy, S.;Downs, J. R.;Gotto, A.;Clearfield, M.;Holdaas, H.;Gordon, D.;Davis, B.;Koren, M.;Dahlof, B.;Poulter, N.;Sever, P.;Knopp, R. H.;Fellstrom, B.;Holdaas, H.;Jardine, A.;Schmieder, R.;Zannad, F.;Goldbourt, U.;Kaplinsky, E.;Colhoun, H. M.;Betteridge, D. J.;Durrington, P. N.;Hitman, G. A.;Fuller, J.;Neil, A.;Wanner, C.;Krane, V.;Sacks, F.;Moye, L.;Pfeffer, M.;Hawkins, C. M.;Braunwald, E.;Kjekshus, J.;Wedel, H.;Wikstrand, J.;Barter, P.;Keech, A.;Tavazzi, L.;Maggioni, A.;Marchioli, R.;Tognoni, G.;Franzosi, M. G.;Maggioni, A.;Bloomfield, H.;Robins, S.;Collins, R.;Armitage, J.;Keech, A.;Parish, S.;Peto, R.;Sleight, P.;Pedersen, T. R.;Ridker, P. M.;Holman, R.;Meade, T.;Simes, J.;Keech, A.;MacMahon, S.;Marschner, I.;Tonkin, A.;Shaw, J.;Serruys, P. W.;Nakamura, H.;Knatterud, G.;Furberg, C.;Byington, R.;Macfarlane, P.;Cobbe, S.;Ford, I.;Murphy, M.;Blauw, G. J.;Packard, C.;Shepherd, J.;Kjekshus, J.;Pedersen, T.;Wilhelmsen, L.;Braunwald, E.;Cannon, C.;Murphy, S.;Collins, R.;Armitage, J.;Bowman, L.;Parish, S.;Peto, R.;Sleight, P.;Baigent, C.;Landray, M.;Collins, R.;La Rosa, J.;Rossouw, J.;Probstfield, J.;Shepherd, J.;Cobbe, S.;Macfarlane, P.;Ford, I.
通讯作者：
Ford, I.
影响因子：
13.8
作者：
Mahtta, Dhruv;Ramsey, David J.;Virani, Salim S.
通讯作者：
Virani, Salim S.
影响因子：
24
作者：
Kohli-Lynch, Ciaran N.;Bellows, Brandon K.;Moran, Andrew E.
通讯作者：
Moran, Andrew E.