[Primary prevention remains expensive, notwithstanding the consensus on lowering serum cholesterol levels].
Recently guidelines for cholesterol lowering therapy by means of 'statines' (HMG-CoA reductase inhibitors) were published by the National Organization of Quality Assurance in Hospitals. The part about primary prevention of cardiovascular disease is based on absolute risks for coronary heart disease as calculated by the Framingham Heart Study risk functions and on a cost-effectiveness analysis. However, the function predicts risk of disease such as silent infarction and angina pectoris. The incidence thus produced is higher than any observed clinical incidence. Absolute risk increases exponentially with age, but remaining life expectancy, and thus benefit, decreases. Therefore, decisions about treatment levels are based on arbitrary assumptions. The function is ultimately only used to advise treatment to the smoker, while the better choice is always to stop smoking. The effectiveness is overestimated by using a long time horizon of treatment of 25 years in the cost-effectiveness analysis. Primary prevention of coronary heart disease according to the new guidelines is still very expensive.
Bonneux
L
L
Erasmus Universiteit, Instituut Maatschappelijke Gezondheidszorg, Rotterdam.
Barendregt
J J
JJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D003327:Coronary Disease / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011322:Primary Prevention / Q000191:economics*; D012306:Risk; D012907:Smoking / Q000009:adverse effects