Background: Statins are effective in the primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline expands recommended statin use, but its cost-effectiveness has not been compared with other guidelines.

Methods: We used the Cardiovascular Disease Policy Model to estimate the cost-effectiveness of the ACC/AHA guideline relative to current use, Adult Treatment Panel III guidelines, and universal statin use in all men 45 to 74 years of age and women 55 to 74 years of age over a 10-year horizon from 2016 to 2025. Sensitivity analyses varied costs, risks, and benefits. Main outcomes were incremental cost-effectiveness ratios and numbers needed to treat for 10 years per quality-adjusted life-year gained.

Results: Each approach produces substantial benefits and net cost savings relative to the status quo. Full adherence to the Adult Treatment Panel III guideline would result in 8.8 million more statin users than the status quo, at a number needed to treat for 10 years per quality-adjusted life-year gained of 35. The ACC/AHA guideline would potentially result in up to 12.3 million more statin users than the Adult Treatment Panel III guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 68. Moderate-intensity statin use in all men 45 to 74 years of age and women 55 to 74 years of age would result in 28.9 million more statin users than the ACC/AHA guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 108. In all cases, benefits would be greater in men than women. Results vary moderately with different risk thresholds for instituting statins and statin toxicity estimates but depend greatly on the disutility caused by daily medication use (pill burden).

Conclusions: At a population level, the ACC/AHA guideline for expanded statin use for primary prevention is projected to treat more people, to save more lives, and to cost less compared with Adult Treatment Panel III in both men and women. Whether individuals benefit from long-term statin use for primary prevention depends more on the disutility associated with pill burden than their degree of cardiovascular risk.

背景：他汀类药物在一级预防动脉粥样硬化性心血管疾病方面有效。2013年美国心脏病学会/美国心脏协会（ACC / AHA）指南扩大了他汀类药物的推荐使用范围，但尚未将其成本效益与其他指南进行比较。

方法：我们使用心血管疾病政策模型估算了ACC / AHA指南相对于当前使用，成人治疗小组III指南以及所有他汀类药物在45至74岁年龄段的男性和55至74岁女性中的通用性的成本效益从2016年到2025年为期10年。主要结果是增加的成本效益比和获得的每质量调整生命年中需要治疗10年的次数。

结果：相对于现状，每种方法都能带来可观的收益和净成本节省。完全遵守成人治疗小组III准则将使他汀类药物使用者比现状多880万，这相当于每增加一个质量调整生命年可获得35年的10年治疗次数。ACC / AHA准则可能会导致比成人治疗小组III指南多增加了1,230万他汀类药物使用者，每经过质量调整生命年需接受10年治疗的边际人数增加了68。在45至74岁的所有男性中中等强度的他汀类药物使用年龄和55至74岁的女性比他的ACC / AHA指南所产生的他汀类药物使用者多2890万，每增加一个经质量调整的生命年（108年），需要10年才能治疗的边际人数。在所有情况下，男性比女性受益更大。在使用他汀类药物和他汀类药物毒性评估的风险阈值不同的情况下，结果略有不同，但很大程度上取决于每天服用药物引起的无用性（药量）。

结论：与成人治疗小组III相比，在人群水平上，与成人治疗小组III相比，ACC / AHA扩大他汀类药物用于一级预防的指南预计将治疗更多的人，挽救更多的生命，并且花费更少。个人是否从长期使用他汀类药物用于一级预防中受益，更多取决于与药丸负担相关的无用性，而不是他们的心血管风险程度。