Annual lipid measurement cost-effective
A major study funded by the National Institute for Health Research concludes that more frequent lipid monitoring strategies are cost-effective when compared with others to guide treatment for prevention of cardiovascular disease (CVD). The study authors concluded that, “Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and the NHS”.
The study was designed to answer questions over which lipid measure and monitoring intervals are the most useful for prognosis and monitoring in primary and secondary CVD prevention.
Two meta-analyses of 90 prospective studies examined associations of lipids with CVD and mortality, and 10 large randomised controlled trials estimated the lipid-lowering effects of atorvastatin doses. Simulation modelling was used to quantify the impact of monitoring strategies on individuals being unnecessarily identified for treatment. This process was extended to an economic model to produce estimates of cost-effectiveness of different lipid-monitoring strategies.
The results showed that, in general, combinations of lipid measures (ratios) show a stronger association with CVD than single measures. In addition, the study concluded that annual monitoring places more people under treatment and is likely to be most cost-effective for primary and secondary prevention when compared with monitoring every 3 years.
- In primary prevention: annual monitoring (compared with 3-yearly monitoring) using a QRisk2 threshold of 20%, would unnecessarily identify 9 per 1000 more men (28 vs 19 per 1000) and 5 per 1000 more women (17 vs 12 per 1000) for treatment over a 3-year period. However, annual monitoring under this scenario would also undertreat 9 per 1000 fewer men (7 vs 16 per 1000) and 4 per 1000 fewer women (7 vs 11 per 1000).
- In secondary prevention: annual monitoring (compared with 3-yearly monitoring) using a total cholesterol threshold of 4mmol/l unnecessarily identifies 66 per 1000 more men (224 vs 157 per 1000) and 31 per 1000 more women (136 vs 105 per 1000) for increased treatment over a 3-year period, with a decrease in those undertreated of 29 per 1000 men (6 vs 36 per 1000) and 28 per 1000 men (5 vs 33 per 1000).
Annual lipid monitoring in people with and without CVD is beneficial to patients and to the NHS. This approach increases the number of people that can benefit from lipid lowering therapy. These findings will be useful to NICE in providing evidence based recommendations on lipid testing.
Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling. Health Technology Assessment 2015;19(100): DOI: http://dx.doi.org/10.3310/hta191000