Objectives: Attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health and economic impact of achieving LDL-C control at different time points.

Methods: We developed a lifetime Markov cohort model (n = 1,000) to estimate the effect on coronary heart disease (CHD) of attaining LDL-C control with no delay (i.e., immediately after a high LDL-C level diagnosis) compared to ten years delay. The effect of LDL-C attainment was tested using either high-intensity statins or combination lipid-lowering treatment (statins plus ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9i]). LDL-C levels were extracted from an Australian primary care cohort treated with low/moderate intensity statins, and LDL-C goal attainment was set at 2 mmol/L, as per Australian guidelines. The effect of LDL-C reduction on CHD risk was assumed to proportional to lifetime exposure and derived from Mendelian randomisation data. Outcomes of interest included events prevented, quality-adjusted life years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICER). All outcomes were annually discounted by 5%.

Results: Over the cohort lifetime horizon, achieving immediate LDL-C control with high intensity statins would double the QALYs gained per person compared to achieving control after 10 years (0.04 vs 0.02 QALYs/person). For statins + ezetimibe, the gains would be 0.11 vs. 0.04 QALYs per per-person, while for statins + PCSK9i the gains would be 0.18 and 0.11 QALYs per-person. From a healthcare perspective, the model yielded cost saving ICERs for both high intensity statins and statins + ezetimibe, while for PCSK9i the ICER remained above the willingness-to-pay threshold.

Conclusions: Delaying attainment of LDL-C targets translates into a lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in patients treated with lipid-lowering therapy.