(Circulation. 2000;102:722.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Cost-Effectiveness of Treating Hyperlipidemia in the Presence of Diabetes
Who Should Be Treated?
From the Centre for the Analysis of Cost-Effective Care (S.A.G., L.C., H.Z., M.D.) and the Divisions of General Internal Medicine and Clinical Epidemiology (S.A.G.), The Montreal General Hospital (S.A.G., L.C., H.Z., M.D.), and the Departments of Medicine and Epidemiology and Biostatistics (S.A.G.), McGill University, Montreal, Quebec, Canada.
Correspondence to Dr Steven A. Grover, Division of Clinical Epidemiology, The Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec, Canada H3G 1A4.
Background—The objective of this study was to estimate the long-term costs and benefits of treating hyperlipidemia among diabetic patients with and without known cardiovascular disease after validating the Cardiovascular Life Expectancy Model.
Methods and Results—The model estimates were compared with the
Scandinavian Simvastatin Survival Study (4S) and used to
estimate the long-term costs and benefits of treatment with
simvastatin. Simulations were performed for men and women,
40 to 70 years of age, having pretreatment LDL cholesterol
values of 5.46, 4.34, and 3.85 mmol/L (211, 168, and 149 mg/dL).
We forecasted the long-term risk of cardiovascular
events, the need for medical and surgical interventions, and the
associated costs in 1996 US dollars. The model validated well against
the observed results of the of the 4S diabetic patients. In this
validation, the model estimates fell within the 95% confidence
interval of the observed results for 7 of the 8 available end points
(coronary deaths, total deaths, and so forth). Treatment with
simvastatin for patients with
cardiovascular disease is cost-effective for men and
women, with or without diabetes. Among diabetic individuals without
cardiovascular disease, the benefits of primary
prevention were also substantial and the cost-effectiveness ratios
attractive across a wide range of assumptions (
$4000 to $40 000 per
year of life saved). These conclusions were robust even among diabetics
with lower baseline LDL values and smaller LDL reductions as observed
in the Cholesterol and Recruitment Events (CARE) trial.
Conclusions—Among adults with hyperlipidemia, the presence of diabetes identifies men and women among whom lipid therapy is likely to be effective and cost-effective even in the absence of other risk factors or known cardiovascular disease.
Key Words: prevention • cardiovascular diseases • diabetes mellitus
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