Strategies for Primary Prevention of XXXX Based on Risk Stratification by the ACC/AHA Lipid Guidelines, ATP III Guidelines, Coronary @entity460 Scoring, and @entity1851 , and a Global Treat-All Strategy: A Comparative--Effectiveness Modeling Study.

@entity1 @entity548 @entity301 @entity5 @entity6 @entity117 @entity460 @entity583 @entity99 @entity121 @entity6817 @entity165 @entity1851
BACKGROUND: Several approaches have been proposed for risk-stratification and primary prevention of @entity301 ( @entity301 ), but their comparative and cost-effectiveness is unknown. METHODS: We constructed a state-transition microsimulation model to compare multiple approaches to the primary prevention of @entity301 in a simulated cohort of @entity1 aged 45-75 and @entity1 55-75. Risk-stratification strategies included the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the treatment of blood @entity165 , the Adult Treatment Panel (ATP) III guidelines, and approaches based on coronary artery @entity460 (CAC) scoring and @entity1851 ( @entity1851 ). Additionally we assessed a treat-all strategy in which all individuals were prescribed either moderate-dose or high-dose statins and all males received low-dose @entity117 . Outcome measures included @entity301 events, costs, medication-related side effects, radiation-attributable @entity5 , and quality-adjusted-life-years (QALYs) over a 30-year timeframe. RESULTS: Treat-all with high-dose statins dominated all other strategies for both @entity1 and @entity1 , gaining 15.7 million QALYs, preventing 7.3 million @entity583 , and saving over  238 billion, compared to the status quo, far outweighing its associated adverse events including @entity548 , @entity99 , @entity121 , and new-onset @entity6 . ACC/AHA guidelines were more cost-effective than ATP III guidelines for both @entity1 and @entity1 despite placing 8.7 million more @entity1 on statins. For @entity1 at low @entity301 risk, treat-all with high-dose @entity6817 was more likely to cause a statin-related adverse event than to prevent a @entity301 event. CONCLUSIONS: Despite leading to a greater proportion of the population placed on statin therapy, the ACC/AHA guidelines are more cost-effective than ATP III. Even so, at generic prices, treating all @entity1 and @entity1 with statins and all @entity1 with low-dose @entity117 appears to be more cost-effective than all risk-stratification approaches for the primary prevention of @entity301 . Especially for low- @entity301 risk @entity1 , decisions on the appropriate primary prevention strategy should be based on shared decision making between @entity1 and healthcare providers.
