12 The economics of cholesterol lowering

Reckless, John

doi:10.1016/s0950-351x(05)80087-4

Baillière's Clinical Endocrinology and Metabolism

1990

DOI: 10.1016/s0950-351x(05)80087-4

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12 The economics of cholesterol lowering

John Reckless¹

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Cited by 11 publications

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References 42 publications

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“…mortality. [1][2][3] Coronary heart disease (CAD) accounts for around 1. Recommendations for Lipid-Modifying Therapy half of cardiovascular deaths.…”

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confidence: 99%

Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease

McCabe

2003

American Journal of Cardiovascular Drugs

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HMG-CoA reductase inhibitors significantly reduce the risk of coronary artery disease (CAD) events and CAD-related mortality in patients with and without established CAD. Consequently, HMG-CoA reductase inhibitors have a central role within recommendations for lipid-modifying therapy. However, despite these guidelines, only one-third to one-half of eligible patients receive lipid-lowering therapy and as few as one-third of these patients achieve recommended target serum levels of low density lipoprotein-cholesterol. The underuse of HMG-CoA reductase inhibitors in eligible patients has important implications for mortality, morbidity and cost, given the enormous economic burden associated with CAD; direct healthcare costs, estimated at US $16-53 billion (2000 values) in the US and 1.6 billion pound (1996 values) in the UK alone, are largely driven by inpatient care. Hospitalization costs are reduced by treatment with HMG-CoA reductase inhibitors, particularly in high-risk groups such as patients with CAD and diabetes mellitus in whom net cost savings may be achieved. HMG-CoA reductase inhibitors are underused because of institutional factors and clinician and patient factors. Also, the vast number of patients eligible for treatment means that the use of HMG-CoA reductase inhibitors is undoubtedly limited by budgetary considerations. Secondary prevention in CAD using HMG-CoA reductase inhibitors is certainly cost effective. Primary prevention with HMG-CoA reductase inhibitors is also cost effective in many patients, depending upon CAD risk and drug dosage. As new, more powerful, HMG-CoA reductase inhibitors come to market, and the established HMG-CoA reductase inhibitors come off patent, the identification of the most cost-effective therapy becomes increasingly complex. Research in to the relative cost effectiveness of alternative HMG-CoA reductase inhibitors, taking full account of the institutional, clinician and patient barriers to uptake should be undertaken to identify the most appropriate role for the new therapies.

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“…mortality. [1][2][3] Coronary heart disease (CAD) accounts for around 1. Recommendations for Lipid-Modifying Therapy half of cardiovascular deaths.…”

mentioning

confidence: 99%

Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease

McCabe

2003

American Journal of Cardiovascular Drugs

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Prevention of cardiovascular disease: From biomedical research to health policy

Muntoni¹

1995

Eur J Epidemiol

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Cardiovascular diseases (CVD) are the leading cause of premature death and disability in the developed world. Broad consensus exists on CVD preventability through reduction of their risk factors at both the individual and population level. The latter kind of intervention implies involvement of policy-making institutions, owing to the manifold implications (agriculture, industry, environment) of such programmes. They have to be developed through three phases in succession: observational studies; intervention trials; public health action programmes. The implementation of the latter can only result from merging of biomedicine and politics and must rest on sound scientific-ethical bases. Other important issues are cost effectiveness, resort to mass media, transfer to other communities, funding and institutionalization. As a practical example of development and implementation of a public health programme, the experience of the ATS-Sardegna Campaign is briefly described.

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Economic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidence

Weijden

Knottnerus

Ament

et al. 1998

Journal of Epidemiology & Community Health

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Study objective-To investigate and evaluate published data on cost eVectiveness of cholesterol lowering interventions, and how this information could be interpreted in a rational approach of cholesterol management in general practice. Design-A systematic review of the literature. Setting-No restriction on setting.Materials-Papers reporting on the cost eVectiveness or cost utility of prevention of (recurrent) coronary heart disease by reduction of hypercholesterolaemia in adults. Main results-Thirty nine studies, most cost eVectiveness analyses, were included. In 24 studies drug interventions only were analysed. Costs of screening to target cholesterol lowering interventions to persons with hypercholesterolaemia were considered in nine studies. Adjustments of the eYcacy of the intervention for community eVectiveness were described in seven studies. In four studies life years gained were adjusted for quality of life. Despite large variation in the outcomes, there is a constant tendency towards a less favourable cost eVectiveness ratio for intervening in persons without coronary heart disease compared with persons with coronary heart disease and for women compared with men. Conclusions-There is lack of data on cost eVectiveness of cholesterol lowering interventions in the general practice setting. The cost eVectiveness of cholesterol lowering in general practice deteriorates when all relevant costs are taken into account and when eYcacy is corrected for community eVectivenes. Cholesterol lowering intervention is more cost eVective in men compared with women and in patients with coronary heart disease compared with persons without coronary heart disease. Considerations from cost eVectiveness analyses should be incorporated into the development and implementation of national cholesterol guidelines for general practitioners. Standardisation of cost eVectiveness studies is important for future economic evaluations. (J Epidemiol Community Health 1998;52:586-594) Controversy surrounds the benefit of cholesterol lowering intervention to prevent coronary heart disease (CHD) in general practice patients. Internationally published guidelines on this topic diVer in their restrictiveness of cholesterol screening, although they are based on the same type of evidence. The source of the the screening strategy: the selection of the part of the population that has to be screened as well as the frequency of screening the diagnostic strategy: the number of tests, the sequency of testing, further diagnostic testing following diVerent results of the screening test, outpatient consultations or primary care consultations the therapeutic strategy: diet therapy: education leaflets, guidance and monitoring by physician or dietitian drug therapy: doses, frequency, number of medication days, guidance and monitoring by physician side eVects of cholesterol lowering therapy: costs of screening for and treatment of side eVects organisational costs: how and who, overhead costs, energy and maintenance, rent/housing plus direct non-medica...

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12 The economics of cholesterol lowering

Cited by 11 publications

References 42 publications

Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease

Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease

Prevention of cardiovascular disease: From biomedical research to health policy

Economic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidence

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