Objective:

To evaluate the cost-effectiveness of using apolipoprotein B (apoB) targets for lipid-lowering therapy in primary prevention of atherosclerotic cardiovascular disease (ASCVD).

Approach:

Key Findings:

• ApoB-guided therapy produced 1,324 additional QALYs compared to non-HDL-C strategy.
• Incremental cost-effectiveness ratio for apoB was $30,300 per QALY gained.
• ApoB strategy prevented 1,018 ASCVD events compared to non-HDL-C and 128,176 total ASCVD events.

Interpretation:

ApoB-guided treatment intensification is more effective and cost-effective in preventing ASCVD compared to non-HDL-C and LDL-C strategies.

Limitations:

• Findings depend on model assumptions regarding treatment effects and costs.
• Study reflects a health sector perspective, not incorporating broader societal outcomes.

Conclusion:

ApoB targets may provide superior guidance for lipid-lowering therapy in primary prevention settings, leading to greater health benefits and cost-effectiveness.

Sources:

• JAMA
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