title: Estimates of commercial population at high risk for cardiovascular events: impact of aggressive cholesterol reduction.
abstract: OBJECTIVE
  To model the financial and health outcomes impact of intensive statin therapy compared with usual care in a high-risk working-age population (actively employed, commercially insured health plan members and their adult dependents). The target population consists of working-age people who are considered high-risk for cardiovascular disease events because of a history of coronary heart disease.
  
  
  METHODS
  Three-year event forecast for a sample population generated from the National Health and Nutrition Examination Survey data.
  
  
  METHODS
  Using Framingham risk scoring system, the probability of myocardial infarction or stroke events was calculated for a representative sample population, ages 35 to 69 years, of people at high risk for cardiovascular disease, with a history of coronary heart disease. The probability of events for each individual was used to project the number of events expected to be generated for this population. Reductions in cardiovascular and stroke events reported in clinical trials with aggressive statin therapy were applied to these cohorts. We used medical claims data to model the cohorts' event costs. All results are adjusted to reflect the demographics of a typical working-age population.
  
  
  RESULTS
  The high-risk cohort (those with coronary heart disease) comprises 4% of the 35- to 69-year-old commercially insured population but generates 22% of the risk for coronary heart disease and stroke. Reduced event rates associated with intensive statin therapy yielded a $58 mean medical cost reduction per treated person per month; a typical payer cost for a 30-day supply of intensive statin therapy is approximately $57.
  
  
  CONCLUSIONS
  Aggressive low-density lipoprotein cholesterol-lowering therapy for working-age people at high risk for cardiovascular events and with a history of heart disease appears to have a significant potential to reduce the rate of clinical events and is cost-neutral for payers.
authors.affiliation: Principal and Healthcare Management Consultant, Ms Goldberg is Consulting Actuary.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fitch
authors.affiliation: Consulting Actuary, Milliman, New York, NY.
authors.forename: Sara W
authors.initials: SW
authors.lastname: Goldberg
authors.affiliation: Consulting Actuary, Milliman, New York, NY.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Iwasaki
authors.affiliation: Principal and Consulting Actuary, Milliman, New York, NY.
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Pyenson
authors.affiliation: Associate Director of Outcome Research, Pfizer Global Pharmaceuticals, New York, NY.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuznik
authors.affiliation: Medical Director, Pfizer Global Pharmaceuticals, New York, NY.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Solomon