TY - JOUR
T1 - Managing to low-density lipoprotein particles compared with low-density lipoprotein cholesterol
T2 - A cost-effectiveness analysis
AU - Rizzo, John A.
AU - Mallow, Peter J.
AU - Waters, Heidi C.
AU - Pokrywka, Gregory S.
N1 - Funding Information:
The study was funded by LipoScience, Inc . John Rizzo is a paid consultant to S 2 Statistical Solutions, Inc. Peter Mallow is an employee of and Heidi Waters was an employee of S 2 Statistical Solutions, Inc., a paid consultant to LipoScience, Inc. Gregory S. Pokrywka is an unpaid advisor to LipoScience, Inc.
PY - 2013/11
Y1 - 2013/11
N2 - 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. Conclusion 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.
AB - 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. Conclusion 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.
KW - Cost of drug therapy
KW - Cost-effectiveness analysis
KW - Cost-utility analysis
KW - LDL-P
KW - Lipoprotein
KW - Statin therapy
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U2 - 10.1016/j.jacl.2013.06.004
DO - 10.1016/j.jacl.2013.06.004
M3 - Article
C2 - 24314363
AN - SCOPUS:84889663892
SN - 1933-2874
VL - 7
SP - 642
EP - 652
JO - Journal of clinical lipidology
JF - Journal of clinical lipidology
IS - 6
ER -