title: Cost Effectiveness of Achieving Targets of Low-Density Lipoprotein Particle Number Versus Low-Density Lipoprotein Cholesterol Level.
abstract: A recent analysis of a commercially insured US population found fewer cardiovascular disease (CVD) events in high-risk patients attaining low levels of low-density lipoprotein (LDL), as measured by LDL particle number (LDL-P) versus low LDL cholesterol (LDL-C). Here, we investigated the cost effectiveness of LDL-lowering therapy guided by LDL-P. Patients were selected from the HealthCore Integrated Research Database and followed for 12 to 36 months. Patients who achieved LDL-P <1,000 nmol/l were placed into the LDL-P cohort, whereas those without LDL-P tests, but who achieved LDL-C <100 mg/dl, were placed into the LDL-C cohort. CVD-related costs included all health plan paid amounts related to CVD events or lipid management. Cost effectiveness was assessed through incremental cost-effectiveness ratios, defined as difference in total costs across the cohorts divided by difference in CVD events, measured over follow-up. Each cohort included 2,094, 1,242, and 705 patients over 12-, 24-, and 36-month follow-up. Patients in the LDL-P cohort received more aggressive lipid-lowering therapy and had fewer CVD events during follow-up compared to patients in the LDL-C cohort. This led to greater pharmacy costs and lower medical costs over time. Incremental cost-effectiveness ratio estimates ranged from $23,131 per CVD event avoided at 12 months to $3,439 and -$4,555 at 24- and 36-month follow-up, suggesting a high likelihood that achieving LDL-P <1,000 nmol/l is cost effective. In conclusion, LDL-lowering therapy guided by LDL-P was demonstrated to be cost effective, with greater clinical and economic benefit seen over longer time horizons and with the increased use of generic statins.
authors.affiliation: HealthCore, Inc., Wilmington, Delaware. Electronic address: mgrabner@healthcore.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Grabner
authors.affiliation: Laboratory Corporation of America Holdings, Raleigh, North Carolina.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Winegar
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Rajeshwari S
authors.initials: RS
authors.lastname: Punekar
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Quimbo
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cziraky
authors.affiliation: Laboratory Corporation of America Holdings, Raleigh, North Carolina.
authors.forename: William C
authors.initials: WC
authors.lastname: Cromwell
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL