Assessing Colorectal Cancer and Mortality Risk in Older Adults

# Assessing Colorectal Cancer and Mortality Risk in Older Adults *Published: 2026 May 5* Cost-Effectiveness of ApoB, Non-HDL-C, and LDL-C Goals for Primary Prevention Lipid-Lowering Therapy. Luebbe S(1), Sniderman AD(2), Moran AE(3), Wilkins JT(4)(5), Kohli-Lynch CN(5). Author information: (1)Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. (2)Mike and Valeria Rosenbloom Center for Cardiovascular Prevention, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada. (3)Division of General Medicine, Columbia University Irving Medical Center, New York, New York. (4)Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. (5)Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Comment on JAMA. 2026 May 5;335(17):1485-1486. doi: 10.1001/jama.2026.3531. ## IMPORTANCE Apolipoprotein B (apoB) is a superior marker of residual atherosclerotic cardiovascular disease risk in patients treated with lipid-lowering therapy (LLT) compared with low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). The cost-effectiveness of LDL-C, non-HDL-C, and apoB goals has not been established. ## OBJECTIVE To determine the relative cost-effectiveness of intensifying LLT for primary prevention based on LDL-C, non-HDL-C, and apoB goals. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a computer simulation model to evaluate the cost-effectiveness of intensifying LLT with high-intensity statins or ezetimibe according to LDL-C, non-HDL-C, or apoB goals. A cohort of 250 000 statin-eligible and atherosclerotic cardiovascular disease-free US adults was constructed from 2005 to 2016 National Health and Nutrition Examination Survey participants (N = 4149). Individuals commenced the simulation after lipid screening and received statin therapy based on 2018 American Heart Association/American College of Cardiology guidelines. Model inputs were derived from national survey data, pooled longitudinal cohort studies, and published literature. Uncertainty was explored with traditional and probabilistic sensitivity analysis. ## EXPOSURES Lipid-lowering therapy was intensified if individuals did not achieve treated LDL-C level less than 100 mg/dL, non-HDL-C level less than 118 mg/dL, or apoB level less than 78.7 mg/dL. MAIN OUTCOMES AND MEASURES Lifetime quality-adjusted life-years (QALYs) and costs (in 2025 US dollars), discounted 3.0% annually. The primary outcome was the incremental cost-effectiveness ratio. Strategies were considered cost-effective if they cost less than $120 000 per QALY gained. ## RESULTS Compared with an LDL-C goal, 965 QALYs (95% uncertainty interval [UI], -3551 to 5341 QALYs) would be gained with a non-HDL-C goal, alongside a $2.1 million (95% UI, -$94.2 million to $92.0 million) reduction in costs. Compared with a non-HDL-C goal, 1324 QALYs (95% UI, -2602 to 5669 QALYs) would be gained with an apoB goal, alongside a $40.2 million (95% UI, -$43.6 million to $134 million) increase in costs, yielding an incremental cost-effectiveness ratio of $30 300 per QALY gained. At a willingness-to-pay threshold of $120 000 per QALY gained, an apoB goal was optimal in 65% of probabilistic analyses and a non-HDL-C goal was optimal in 25%. The cost of apoB testing was marginal; higher costs reflected longer life expectancy and prolonged preventive treatment. CONCLUSIONS AND RELEVANCE The results of this computer simulation study suggest that apoB can be used as a cost-effective marker to guide primary prevention LLT and improve population health. DOI: 10.1001/jama.2026.2986 PMCID: PMC13063141 DOI: 10.1001/jama.2026.2657