Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States.
Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States.
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DOI：
10.7326/m14-1430
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发表时间：
2015-04-21
影响因子：
39.2
通讯作者：
Bibbins-Domingo K
中科院分区：
文献类型：
--
作者：
Odden MC;Pletcher MJ;Coxson PG;Thekkethala D;Guzman D;Heller D;Goldman L;Bibbins-Domingo K
超过40%的75岁及以上的成年人正在服用他汀类药物，但几乎没有证据来指导这一人群的初级预防。预测他汀类药物在75岁及以上成年人中的人口影响和成本效益。使用马尔可夫模型的心血管疾病政策模型的预测研究。试验、队列和具有全国代表性的数据源。年龄在75-94岁的美国成年人。十年了。医疗保健系统。他汀类药物的一级预防依据：1)低密度脂蛋白胆固醇≥4.91mmo1/L(190 mg/dL)，2)≥4.14mmo1/L(160mgdL)，3)≥3.36mmo1/L(130mgdL)，4)糖尿病，5)10年危险评分≥7.5%(治疗ALL)。心肌梗死(MI)、冠心病(CHD)死亡、残疾调整后的寿命年、费用在NHANES中所有75岁及以上的成年人都有10年风险评分&>7.5%。如果他汀类药物对功能受限或认知损害没有影响，所有的一级预防策略都将防止误诊和冠心病死亡，并且具有成本效益。最广泛的战略是，对所有75-94岁的成年人进行治疗，将导致新增800万使用者，并防止105,000例(4.3%)事件失误和68,000例(2.3%)冠心病死亡，每残疾调整寿命年的增量成本为25,200美元。功能受限或轻度认知障碍的相对风险在1.10至1.30之间的增加可能会抵消心血管方面的好处。针对75岁及以上成年人一级预防的试验证据有限。在与试验结果相似的效果下，他汀类药物预计对75-94岁的成年人来说是具有成本效益的一级预防；然而，即使老年特定副作用的小幅增加也可能抵消心血管方面的好处。需要改善有关他汀类药物潜在益处和危害的数据，以便为决策提供信息。
Over 40% of adults 75 and older are taking statins, yet there is little evidence to guide primary prevention in this population. To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years and older. Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. Trial, cohort, and nationally-representative data sources. U.S. adults aged 75–94 years. 10 years. Health care system. Statins for primary prevention based on: 1) Low density lipoprotein cholesterol ≥4.91 mmol/L (190 mg/dL), 2) ≥4.14 mmol/L (160 mg/dL), 3) ≥3.36 mmol/L (130 mg/dL), 4) diabetes, 5) 10-year risk score ≥7.5% (treat all). Myocardial infarction (MI), coronary heart disease (CHD) death, disability adjusted life years, costs All adults aged 75 and older in NHANES have a 10-year risk score >7.5%. If statins have no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost effective. The broadest strategy, treatment of all adults aged 75–94 years would result in 8 million additional users, and prevent 105,000 (4.3%) incident MIs and 68,000 (2.3%) CHD deaths at an incremental cost per disability adjusted life year of $25,200. An increased relative risk of functional limitation or mild cognitive impairment in the range of 1.10 to 1.30 could offset the cardiovascular benefits. Limited trial evidence targeting primary prevention in adults 75 and older. At effectiveness similar to trial findings, statins are projected to be cost-effective for primary prevention in adults age 75–94 years; however, even a small increase in geriatric specific side effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision-making.