title: Managing to low-density lipoprotein particles compared with low-density lipoprotein cholesterol: a cost-effectiveness analysis.
abstract: BACKGROUND
  Meta-analyses of clinical trials have shown that using statins to lower low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular events, and more intensive lowering of LDL-C further decreases the risk of occlusive vascular events. Lipoprotein studies suggest treating patients more aggressively when low-density lipoprotein particle (LDL-P) number is discordantly high in the presence of normal LDL-C levels. Failure to manage LDL-P numbers may lead to additional direct and indirect costs.
  
  
  OBJECTIVE
  This analysis modeled direct and indirect costs associated with cardiovascular events due to suboptimal treatment resulting from discordance between LDL-C and LDL-P levels.
  
  
  METHODS
  The analysis was conducted from the payer perspective and the employer perspective, respectively, over a 3-year time period. Clinical data were obtained from the Multi-Ethnic Study of Atherosclerosis, a community-based population study. The employer perspective included indirect costs and quality-adjusted life years in addition to the direct costs and cardiovascular disease events considered in the payer analysis. All costs are reported in 2011 dollars.
  
  
  RESULTS
  From the payer perspective, managing LDL-C and LDL-P in comparison with LDL-C alone reduced costs ($21,212) and cardiovascular events (9 events). Similar patterns were observed for managing LDL-P alone in comparison with LDL-C. From the employer perspective, managing both LDL-P alone or in combination with LDL-C also resulted in lower costs, fewer cardiovascular disease events, and increased quality-adjusted life years in comparison with LDL-C.
  
  
  CONCLUSIONS
  This analysis indicates that the benefits of additional testing to optimally manage LDL-P levels outweigh the costs of more aggressive treatment. These favorable results depended on the cost of drug therapy.
authors: Stony Brook University, Stony Brook, NY, USA.
authors: John A
authors: JA
authors: Rizzo
authors: Peter J
authors: PJ
authors: Mallow
authors: Heidi C
authors: HC
authors: Waters
authors: Gregory S
authors: GS
authors: Pokrywka
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D008078:Cholesterol, LDL / Q000097:blood*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL
keywords: Cost of drug therapy; Cost-effectiveness analysis; Cost-utility analysis; LDL-P; Lipoprotein; Statin therapy