Cost-effectiveness of cholesterol-lowering therapies according to selected patient characteristics.
BACKGROUND
The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) recommends treatment guidelines based on cholesterol level and number of risk factors.


OBJECTIVE
To evaluate how the cost-effectiveness ratios of cholesterol-lowering therapies vary according to different risk factors.


METHODS
Cost-effectiveness analysis.


METHODS
Published data.


METHODS
Women and men 35 to 84 years of age with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (> or =160 mg/dL), divided into 240 risk subgroups according to age, sex, and the presence or absence of four coronary heart disease risk factors (smoking status, blood pressure, low-density lipoprotein cholesterol level, and high-density lipoprotein cholesterol level).


METHODS
30 years.


CONCLUSIONS
Societal.


METHODS
Step I diet, statin therapy, and no preventive treatment for primary and secondary prevention.


METHODS
Incremental cost-effectiveness ratios.


RESULTS
Incremental cost-effectiveness ratios for primary prevention with step I diet ranged from $1900 per quality-adjusted life-year (QALY) gained to $500000 per QALY depending on risk subgroup characteristics. Primary prevention with a statin compared with diet therapy was $54000 per QALY to $1400000 per QALY. Secondary prevention with a statin cost less than $50000 per QALY for all risk subgroups.


RESULTS
The inclusion of niacin as a primary prevention option resulted in much less favorable incremental cost-effectiveness ratios for primary prevention with a statin (>$500000 per QALY).


CONCLUSIONS
Cost-effectiveness of treatment strategies varies significantly when adjusted for age, sex, and the presence or absence of additional risk factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but may not be cost-effective for otherwise healthy young women. Primary prevention with a statin may not be cost-effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age ranges. Secondary prevention with a statin seems to be cost-effective for all risk subgroups and is cost-saving in some high-risk subgroups.
Prosser
L A
LA
Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.
Stinnett
A A
AA
Goldman
P A
PA
Williams
L W
LW
Hunink
M G
MG
Goldman
L
L
Weinstein
M C
MC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003198:Computer Simulation; D003327:Coronary Disease / Q000209:etiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D017035:Pravastatin