Study Compares Treat-to-Target Strategies to Tailored Approach for Statin Therapy
FINDINGS:
- A simple Tailored Treatment strategy for statin therapy was more efficient and prevented substantially more coronary artery disease (CAD) morbidity and mortality than any of the currently recommended Treat-to-Target approaches.
- The Tailored Treatment approach was predicted to save 520,000 more quality-adjusted life years among Americans aged 30-75 than the best NCEP III Treat-to-Target approach for every five years of treatment, even though fewer people were treated with high doses of statins.
- The authors indicate that these results suggest that a Tailored Treatment approach to medicine can substantially improve care, while also reducing unnecessary treatment and costs. Thus, they recommend that given its potential to better tailor treatments to individual patients, the principles underlying a Tailored Treatment approach should be considered during deliberations about guidelines and performance measures.
BACKGROUND:
Statins are one of the most effective treatments in medicine, yet several controversies remain about their use. Although treating to lipid targets (Treat-to-Target) is widely recommended for coronary artery disease (CAD) prevention, some have advocated giving fixed doses of statins based upon an individual's estimated net benefit (Tailored Treatment). This study examined how a simple Tailored Treatment strategy compared with a Treat-to-Target strategy based on National Cholesterol Education Program (NCEP) III treatment recommendations. Investigators simulated the population-level impact of competing statin treatment guidelines using data from statin trials conducted from 1994 to 2009 and nationally-representative CAD risk factor data for Americans aged 30-75 with no history of heart attack. Outcomes were benefits achieved for a 5-year treatment period, e.g., quality-adjusted life-years (QALYs) gained.
LIMITATIONS:
- Model assumptions were based on available clinical data, which included few individuals age 75 years and older, thus making recommendations for this group more uncertain.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by VA/HSR&D's Quality Enhancement Research Initiative (QUERI). Drs. Hayward and Vijan are part of HSR&D's Center for Clinical Management Research in Ann Arbor, MI.
Hayward R, Krumholz H, Zulman D, Timbie J, and Vijan S. Optimizing Statin Treatment for Primary Coronary Artery Disease Prevention. Annals of Internal Medicine January 19, 2010;152(2):69-77.
