Cost-Effectiveness of the 2026 ACC/AHA Statin Recommendations for Primary Prevention: A Microsimulation of US Adults Using the PREVENT Equations

Preprint – not peer reviewed.

Objectives

The 2026 American College of Cardiology/American Heart Association (ACC/AHA) dyslipidemia guideline adopted the PREVENT equations, lowered statin thresholds and added routes for younger and lower-risk adults. We estimated the cost-effectiveness of these recommendations and of each new eligibility route.

Methods

We built an individual-level state-transition model populated with 3,576 participants aged 30–79 years without atherosclerotic cardiovascular disease (ASCVD) or statin use from NHANES 2017–2023, representing 124.6 million US adults. We compared the 2018 and 2026 rules, the 2026 rules without each route, and single PREVENT thresholds from 1% to 20%. Inputs came from trial meta-analyses and published US sources. We used a lifetime horizon, the health care sector perspective, 2025 US dollars and 3% discounting, with deterministic, scenario and probabilistic analyses.