Circulation, Vol 85, 1960-1968, Copyright © 1992 by American Heart Association
L Goldman, DJ Gordon, BM Rifkind, SB Hulley, AS Detsky, DW Goodman, B Kinosian and MC Weinstein
BACKGROUND. A broad, scientific consensus supports the role of cholesterol
as a risk factor for coronary heart disease and agrees that lowering
cholesterol levels will reduce coronary heart disease incidence.
Cost-effectiveness analysis is a potentially powerful method for measuring
the benefits to be achieved by expenditures of health care dollars. METHODS
AND RESULTS. The literature related to the effectiveness and
cost-effectiveness of cholesterol lowering was reviewed. Application of
cost-effectiveness methodology to the question of cholesterol reduction
generally supports the use of population-wide educational programs and the
aggressive use of cholesterol-lowering therapy for the secondary prevention
of subsequent coronary events in persons with preexisting coronary heart
disease. For primary prevention, however, therapy with medication has a
favorable cost- effectiveness ratio only in identifiable high-risk persons,
and the different costs of the various available medications should be
taken into account. Therapy with medications, especially for primary
prevention, would be more appealing if the price of the available
medications were lower. CONCLUSIONS. High priority should be given to
research that could validate these cost-effectiveness projections as well
as to further studies of the elderly and women, in whom direct data on the
precise costs, risks, and benefits of interventions to lower cholesterol
remain sparse.
ARTICLES
Cost and health implications of cholesterol lowering
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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