Fitch Kathryn, Goldberg Sara W, Iwasaki Kosuke, Pyenson Bruce S, Kuznik Andreas, Solomon Henry A
Principal and Healthcare Management Consultant, Ms Goldberg is Consulting Actuary.
Consulting Actuary, Milliman, New York, NY.
Am Health Drug Benefits. 2009 Sep;2(6):224-32.
To model the financial and health outcomes impact of intensive statin therapy compared with usual care in a high-risk working-age population (actively employed, commercially insured health plan members and their adult dependents). The target population consists of working-age people who are considered high-risk for cardiovascular disease events because of a history of coronary heart disease.
Three-year event forecast for a sample population generated from the National Health and Nutrition Examination Survey data.
Using Framingham risk scoring system, the probability of myocardial infarction or stroke events was calculated for a representative sample population, ages 35 to 69 years, of people at high risk for cardiovascular disease, with a history of coronary heart disease. The probability of events for each individual was used to project the number of events expected to be generated for this population. Reductions in cardiovascular and stroke events reported in clinical trials with aggressive statin therapy were applied to these cohorts. We used medical claims data to model the cohorts' event costs. All results are adjusted to reflect the demographics of a typical working-age population.
The high-risk cohort (those with coronary heart disease) comprises 4% of the 35- to 69-year-old commercially insured population but generates 22% of the risk for coronary heart disease and stroke. Reduced event rates associated with intensive statin therapy yielded a $58 mean medical cost reduction per treated person per month; a typical payer cost for a 30-day supply of intensive statin therapy is approximately $57.
Aggressive low-density lipoprotein cholesterol-lowering therapy for working-age people at high risk for cardiovascular events and with a history of heart disease appears to have a significant potential to reduce the rate of clinical events and is cost-neutral for payers.
对高强度他汀类药物治疗与常规治疗相比，在高风险工作年龄人群（在职、参加商业保险的健康计划成员及其成年家属）中的财务和健康结果影响进行建模。目标人群为因冠心病病史而被认为有心血管疾病事件高风险的工作年龄人群。
根据国家健康与营养检查调查数据生成的样本人群的三年事件预测。
使用弗雷明汉风险评分系统，为年龄在35至69岁、有冠心病病史、心血管疾病高风险的代表性样本人群计算心肌梗死或中风事件的概率。每个个体的事件概率用于预测该人群预期发生的事件数量。将积极他汀类药物治疗临床试验中报告的心血管和中风事件减少情况应用于这些队列。我们使用医疗理赔数据对队列的事件成本进行建模。所有结果均进行调整以反映典型工作年龄人群的人口统计学特征。
高风险队列（有冠心病者）占35至69岁参加商业保险人群的4%，但产生了22%的冠心病和中风风险。与高强度他汀类药物治疗相关的事件发生率降低，使每位接受治疗的人每月平均医疗成本降低58美元；高强度他汀类药物治疗30天供应量的典型支付方成本约为57美元。
对有心血管事件高风险且有心脏病史的工作年龄人群进行积极的低密度脂蛋白胆固醇降低治疗，似乎有显著潜力降低临床事件发生率，且对支付方而言成本中性。
