Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while?
OBJECTIVE
To evaluate the relative cost effectiveness of various cholesterol lowering programmes.


METHODS
Retrospective analysis.


METHODS
Norwegian cholesterol lowering programme in Norwegian male population aged 40-49 (n = 200,000), whose interventions comprise a population based promotion of healthier eating habits, dietary treatment (subjects with serum cholesterol concentration 6.0-7.9 mmol/l), and dietary and drug treatment combined (serum cholesterol concentration greater than or equal to 8.0 mmol/l).


METHODS
Marginal cost effectiveness ratios--that is, the ratio of net treatment costs (cost of treatment minus savings in treatment costs for coronary heart disease) to life years gained and to quality of life years (QALYs) saved.


RESULTS
The cost per life year gained over 20 years of a population based strategy was projected to be 12 pounds. For an individual strategy based on dietary treatment the cost was about 12,400 pounds per life year gained and 111,600 pounds if drugs were added for 50% of the subjects with serum cholesterol concentrations greater than or equal to 8.0 mmol/l.


CONCLUSIONS
The results underline the importance of marginal cost effectiveness analyses for incremental programmes of health care. The calculations of QALYs, though speculative, indicate that individual intervention should be implemented cautiously and within more selected groups than currently recommended. Drugs should be reserved for subjects with genetic hypercholesterolaemia or who are otherwise at very high risk of arteriosclerotic disease.
Kristiansen
I S
IS
Institute of Community Medicine, University of Tromsø, Norway.
Eggen
A E
AE
Thelle
D S
DS
D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood*; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D003327:Coronary Disease / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D006937:Hypercholesterolemia / Q000178:diet therapy; D008297:Male; D008875:Middle Aged; D009664:Norway; D011788:Quality of Life; D012189:Retrospective Studies; D026712:Value of Life
D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D002784:Cholesterol