Prevention & lipidsResearch article
Cost-Effectiveness of ApoB, Non–HDL-C, and Low-density Lipoprotein Cholesterol (LDL-C) Goals for Primary Prevention Lipid-Lowering Therapy
- Economic evaluation (computer simulation model)
- probabilistic sensitivity analysis
- lifetime horizon
- discounted 3.0% annually
Authors' conclusion
The results of this computer simulation study suggest that apoB can be used as a cost-effective marker to guide primary prevention LLT and improve population health.
Study context
- Population
- Simulated statin-eligible, ASCVD-free US adults from NHANES 2005–2016, statin therapy per 2018 AHA/ACC guidelinessimulated cohort
- Participants
- 250,000 participants
- Comparison
- Lipid-lowering therapy (LLT) intensification by Apolipoprotein B (apoB) vs non-HDL-C vs LDL-C goals
- Outcome
- Incremental cost-effectiveness ratio (lifetime QALYs and costs, 2025 US dollars; cost-effective if <$120 000 per QALY gained)
- Follow-up
- Lifetime
Main finding
As reported in the abstract
Incremental QALYs, costs and ICER
- Non-HDL-C goal vs LDL-C goal · 95% UI
- Quality-adjusted life-years (QALYs) gained 965 QALYs (95% UI −3551 to 5341)
- Non-HDL-C goal vs LDL-C goal · 95% UI
- reduction in costs $2.1 million (95% UI -$94.2 million to $92.0 million)
- ApoB goal vs Non-HDL-C goal · 95% UI
- QALYs gained 1324 QALYs (95% UI −2602 to 5669)
- ApoB goal vs Non-HDL-C goal · 95% UI
- increase in costs $40.2 million (95% UI -$43.6 million to $134 million)
- ApoB goal vs Non-HDL-C goal
- incremental cost-effectiveness ratio $30 300 per QALY gained
Further findings
| Outcome | LDL-C goal | Non-HDL-C goal | ApoB goal |
|---|---|---|---|
| Probabilistic analyses at WTP $120 000 per QALY gained · proportion of analyses in which strategy optimal | Not reported in the abstract | 25% | 65% |
Cost drivers
- Cost of apoB testing marginal; higher costs reflected longer life expectancy and prolonged preventive treatment
Original publication
Cost-Effectiveness of ApoB, Non–HDL-C, and LDL-C Goals for Primary Prevention Lipid-Lowering Therapy. JAMA. Published 5 May 2026. doi:10.1001/jama.2026.2986
Summarised from the published abstract; every number is checked against it