Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults

BACKGROUND Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood (aged 18-39 years) is associated with atherosclerotic cardiovascular disease (ASCVD) later in life. Most young adults with elevated LDL-C do not currently receive lipid-lowering treatment. OBJECTIVES This study aimed to estimate the prevalence of elevated LDL-C in ASCVD-free U.S. young adults and the cost-effectiveness of lipid-lowering strategies for raised LDL-C in young adulthood compared with standard care. METHODS The prevalence of raised LDL-C was examined in the U.S. National Health and Nutrition Examination Survey. The CVD Policy Model projected lifetime quality-adjusted life years (QALYs), health care costs, and incremental costeffectiveness ratios (ICERs) for lipid-lowering strategies. Standard care was statin treatment for adults aged >_40 years based on LDL-C, ASCVD risk, or diabetes plus young adults with LDL-C >_190 mg/dL. Lipid lowering incremental to standard care with moderate-intensity statins or intensive lifestyle interventions was simulated starting when young adult LDL-C was either >_160 mg/dL or >_130 mg/dL. RESULTS Approximately 27% of ASCVD-free young adults have LDL-C of >_130 mg/dL, and 9% have LDL-C of >_160 mg/dL. The model projected that young adult lipid lowering with statins or lifestyle interventions would prevent lifetime ASCVD events and increase QALYs compared with standard care. ICERs were US$31,000/QALY for statins in young adult men with LDL-C of >_130 mg/dL and US$106,000/QALY for statins in young adult women with LDL-C of >_130 mg/dL. Intensive lifestyle intervention was more costly and less effective than statin therapy. CONCLUSIONS Statin treatment for LDL-C of >_130 mg/dL is highly cost-effective in young adult men and intermediately cost-effective in young adult women. (J Am Coll Cardiol 2021;78:1954-1964) (c) 2021 by the American College of Cardiology Foundation.

Automated summary

The study revealed that around 27% of ASCVD-free young adults in the United States have LDL-C levels >_130 mg/dL, and 9% have LDL-C >_160 mg/dL. Using statins or lifestyle interventions for lipid-lowering can prevent ASCVD events and increase QALYs compared to standard care.