title: Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States.
abstract: BACKGROUND
  Evidence to guide primary prevention in adults aged 75 years or older is limited.
  
  
  OBJECTIVE
  To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older.
  
  
  METHODS
  Forecasting study using the Cardiovascular Disease Policy Model, a Markov model.
  
  
  METHODS
  Trial, cohort, and nationally representative data sources.
  
  
  METHODS
  U.S. adults aged 75 to 94 years.
  
  
  METHODS
  10 years.
  
  
  CONCLUSIONS
  Health care system.
  
  
  METHODS
  Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%.
  
  
  METHODS
  Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs.
  
  
  RESULTS
  All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 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.
  
  
  RESULTS
  An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits.
  
  
  CONCLUSIONS
  Limited trial evidence targeting primary prevention in adults aged 75 years or older.
  
  
  CONCLUSIONS
  At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making.
  
  
  BACKGROUND
  American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Pletcher
authors.forename: Pamela G
authors.initials: PG
authors.lastname: Coxson
authors.forename: Divya
authors.initials: D
authors.lastname: Thekkethala
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.forename: David
authors.initials: D
authors.lastname: Heller
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003072:Cognition Disorders / Q000139:chemically induced; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors