Impact of Ldl-C Goal Attainments and Cost of Management Following the 2013 Acc/Aha Guideline Among Statin Users in Hong Kong Chinese: Real-World Results

Objectives This study aimed to investigate LDL-C goal attainment rates among statin users in Hong Kong, and to estimate the cost accompanying optimization of statin therapy according to the 2013 ACC/AHA guideline. Methods Patients who were taking statin in Jan 2014 were recruited. Their LDL-C measurements at baseline and 1 year after baseline were retrieved. Percentages of patients who achieved LDL-C goals of <100 mg/dL, <70mg/dL and ≥50% at 1-year were calculated separately for maintenance users and new users of statin. Based on governmental data, cost accompanying optimization of statin therapy for coronary heart disease (CHD) patients was estimated. Results A total of 502 statin users, consisting of 423 maintenance users and 79 new users, completed 1-year follow-up. Of all 238 (47.4%) and 242 (48.2%) adhered to moderate- and low-potency statin respectively. Only 22 (5.0% of maintenance users, 1.3% of new users) were discharged with high-potency statin. Maintenance users’ LDL-C levels remained stable; but 70.4% and 80.7% of them, respectively, not at LDL-C goals of <100mg/dL and <70mg/dL at baseline did not achieve them over 1 year. At 1 year, 64.6% and 39.2% of new users achieved LDL-C goals of <100mg/dl and <70mg/dL. About one fifth of new users and 1.2% of maintenance users met ≥50% reduction target. The 2013 ACC/AHA guideline resulted in more patients eligible for high-potency statin. To achieve the new LDL-C goal of ≥50% reduction, it would cost Hong Kong government an additional budget of HK$ 352 million (US$ 45million) for maintaining existing CHD patients and another 6.7 million (US$0.9 million) for new-onset CHD patients per year. Conclusions This study revealed unsatisfactory LDL-C goal attainment among Chinese statin users and potential increase of health expenditure to have patients on aggressive statin therapy. The reasonableness of additional cost remains unknown, and more cost/value research is highly recommended.