14 May Coronary Calcium Score Can Lead to Cost-Effective Statin Treatment in African Americans
MedicalResearch.com Interview with:
Dr. Ankur Pandya, PhD
Assistant Professor of Health Decision Science
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study?
Response: The 2013 ACC-AHA cholesterol treatment guidelines greatly expanded statin medication eligibility for individuals between the ages of 40-75 years without known cardiovascular disease, and there was some concern that African Americans at “intermediate risk” per those guidelines could be (arguably) overtreated with statins.
The 2018 ACC-AHA guidelines included coronary artery calcium assessment for individuals at intermediate cardiovascular disease risk; those with a “zero” calcium score and no other risk factors would now change the eligibility (from indicated statin to not indicated).
MedicalResearch.com: What are the main findings?
Response: We performed a cost-effectiveness analysis of the 2018 guidelines vs. 2013 guidelines for African American individuals to weigh the tradeoffs of costs, treatment benefits, and treatment harms, and found that the 2018 guidelines were cost-effective when patients had some (or strong) preference to avoid statin treatment.
MedicalResearch.com: What should readers take away from your report?
Response: Our results were sensitive to assumptions around patient preference for taking statin medication. If patients did not mind taking a pill daily, then the 2013 guidelines (that resulted in more widespread statin treatment eligibility) were optimal. However, for patients who would be willing to trade 2 weeks of life lost to avoid decade of statin therapy (about 10-20% of the general population have this kind of preference to avoid taking a pill daily), then the 2018 guidelines would be optimal (because the additional information from the calcium score could change the treatment recommendation). Therefore it is important for African American patients at intermediate risk to discuss their treatment preferences with their physicians when making statin treatment decisions.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our model did not include changes in statin medication adherence as a result of a patient knowing their calcium score. It is plausible that patients who learn they have a non-zero calcium score might be more compliant with their medication, which could affect the cost-effectiveness analysis we performed, but we could not find such a study in the literature, therefore we assumed no change in statin adherence based on patient knowledge of their calcium score.
No disclosures from the lead study authors. Funding for the study was provided from the NIH.
Spahillari A, Zhu J, Ferket BS, et al. Cost-effectiveness of Contemporary Statin Use Guidelines With or Without Coronary Artery Calcium Assessment in African American Individuals. JAMA Cardiol. Published online May 13, 2020. doi:10.1001/jamacardio.2020.1240
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