Estimated Impact of US Preventive Services Task Force
Recommendations on Use and Cost of Statins for Cardiovascular
Quyen Ngo-Metzger, MD, MPH, Samuel H. Zuvekas, PhD, and Arlene S. Bierman, MD, MS
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA.
BACKGROUND: US Preventive Services Task Force
(USPSTF) released new recommendations on statin use
for atherosclerotic cardiovascular disease (ASCVD) pre-
vention. The Affordable Care Act (ACA) mandates USPSTF
recommendations with an BA^ or BB^ grade receive insur-
ance coverage without copayment. We assessed the po-
tential impact of these recommendations.
OBJECTIVE: To assess the US population meeting crite-
ria for statin use and factors associated with use, and
calculate associated costs.
DESIGN AND MEASURES: We estimated 10-year ASCVD
event risk scores from National Health and Nutrition Ex-
amination Survey data using Pooled Cohort Equations
from the American College of Cardiology/American Heart
Association and applied them to Medical Expenditure
Panel Survey data. We estimated the population meeting
USPSTF criteria and calculated the number of statin pre-
scription fills and out-of-pocket and total costs. We
assessed associations between statin use and sociodemo-
graphic and health characteristics and national trends in
use from 1996 to 2014.
PARTICIPANTS: A nationally representative sample of
people aged ≥ 40 years, representing 150 million people
living in the USA.
KEY RESULTS: Of 26.8 million adults recommended for
statins, only 41.8% were taking them. Female sex, His-
panic ethnicity, uninsured status, or living in the South
was associated with lower odds of using statins. Under
ACA, people with private insurance would avoid out-of-
pocket cost of $9 for each generic prescription, resulting
in savings of approximately $44 in annual costs. ACA’s
mandate for insurance coverage would result in a $193
million shift in out-of-pocket cost for statins from patients
to private insurers.
CONCLUSIONS: New USPSTF recommendations may re-
sult in decreased out-of-pocket costs and expanded ac-
cess to statins. Previous research has shown that elimi-
nating copayments increased adherence and decreased
rates of ASCVD events without increasing overall
healthcare costs. Future research will determine whether
the USPSTF’s recommendations will result in similar
KEY WORDS: prevention; statin; cholesterol; cardiovascular; cost.
J Gen Intern Med 33(8):1317–23
© Society of General Internal Medicine (This is a U.S. Government work and not
under copyright protection in the US; foreign copyright protection may apply) 2018
Atherosclerotic cardiovascular disease (ASCVD) is the lead-
ing cause of morbidity and mortality in adults aged 40 years
and older, accounting for one of every three deaths in the USA.
Risk factors for ASCVD include hypertension, hyperlipid-
emia, and smoking; approximately 47% of Americans have
at least one of these three risk factors.
Statins have been shown to be an important tool in reducing
the risk of atherosclerotic cardiovascular events. In November
2016, the US Preventive Services Task Force (USPSTF) rec-
ommended statin use in adults aged 40 to 75 years without a
history of ASCVD who have one or more ASCVD risk factors
and a calculated 10-year ASCVD event risk of 10% or greater
The USPSTF also recommended that clinicians
offer statins to adults aged 40 to 75 years without a history of
ASCVD who have one or more ASCVD risk factors and a
calculated 10-year ASCVD event risk of 7.5 to 10% (BC^
grade for individualized decision making based on patient
The USPSTF did not recommend for or against
starting statin therapy for primary prevention in adults aged
76 years and older, citing lack of evidence to make a recom-
mendation (I statement, or Binsufficient evidence^).
recent USPSTF recommendations can potentially affect a
large number of the US adult population and expand statin use.
The Affordable Care Act (ACA) mandates that USPSTF
recommendations with an BA^ or BB^ grade have first-dollar
insurance coverage without patient copayment, potentially
resulting in many more Americans having access to statins
without out-of-pocket costs. Greater out-of-pocket costs for
statin medications have been associated with fewer prescrip-
tions filled by patients and reductions in statin adherence.
Zero out-of-pocket cost may induce more patients to fill their
statin prescriptions. Previous research has shown that
The opinions stated in this paper are those of the authors and are not that
of the Agency for Healthcare Research and Quality (AHRQ) nor the US
Department of Health and Human Services.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11606-018-4497-4) contains supplementary
material, which is available to authorized users.
Received August 23, 2017
Revised January 26, 2018
Accepted May 11, 2018
Published online May 31, 2018