Cost-effectiveness of drug therapy for hypercholesterolaemia: a review of the literature.
In this article we review published studies of the cost-effectiveness of drug therapy for hypercholesterolaemia to take stock of the principal findings that have been reported to date.  We identified 9 studies that met all criteria for inclusion in our review, including 3 of bile-acid sequestrants (cholestyramine, colestipol), 2 of HMG-CoA reductase inhibitor (lovastatin), and 4 that considered both an HMG-CoA reductase inhibitor (simvastatin) and a bile-acid sequestrant (cholestyramine). While these studies were largely consistent in methodological approach, some differences were noted in the costs attributed to drug therapy. The cost-effectiveness of therapy with bile-acid sequestrants was found to range from $100 000 to $209 000 per year of life saved (1991 $US) for middle-aged men (42 to 55 years of age) with moderately high cholesterol levels (280 to 290 mg/dl) and otherwise average coronary risk characteristics.  Corresponding cost-effectiveness ratios that have been reported for lovastatin range from $64 000 to $82 000, while those for simvastatin range from $45 000 to $65 000.  Studies to date therefore suggest that therapy with HMG-CoA reductase inhibitors (i.e. lovastatin and simvastatin) is substantially more cost-effective than treatment with bile-acid sequestrants.
Thompson
D
D
Policy Analysis Inc., Brookline, Massachusetts.
Oster
G
G
D000367:Age Factors; D002792:Cholestyramine Resin / Q000191:economics / Q000627:therapeutic use; D003084:Colestipol / Q000191:economics / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications; D003362:Cost-Benefit Analysis; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008148:Lovastatin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome