THE COST-EFFECTIVENESS OF HMG-COA REDUCTASE INHIBITORS TO PREVENT CORONARY HEART-DISEASE - ESTIMATING THE BENEFITS OF INCREASING HDL-C

Objective.-To evaluate the lifetime cost-effectiveness of 3-hydroxy-3- methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors for treatment of high blood cholesterol levels. Design.-We added cost data to a val idated coronary heart disease (CHD) prevention computer model that est imates the benefits of lifelong risk factor modification. The updated model takes into account the costs of cholesterol reduction, the savin gs in CHD health care costs attributable to intervention, the addition al non-CHD costs resulting from patients' living longer, and the benef icial effects of reducing CHD risk by reducing total cholesterol and i ncreasing high-density lipoprotein cholesterol (HDL-C). Patients.-Men and women aged 30 to 70 years who were free of CHD, had total choleste rol levels equal to the 90th percentile of the US distribution in thei r age and sex group, had HDL-C levels equal to the mean of the US dist ribution in their age and sex group, and were either with or without a dditional CHD risk factors. Intervention.-Use of 20 mg of lovastatin p er day, which on average reduces total serum cholesterol by 17% and in creases HDL-C by 7%. Main Outcome Measures.-Cost per year of life save d after discounting benefits and costs by 5% annually. Results.-The in crease in HDL-C associated with lovastatin lowered cost-effectiveness ratios by approximately 40%, such that the treatment of hypercholester olemia was relatively cost-effective for men (as low as $20 882 per ye ar of life saved at age 50 years) and women ($36 627 per year of life saved at age 60 years) with additional risk factors. Non-CHD costs res ulting from longer life expectancy after intervention added at most 23 % to the cost-effectiveness ratios for patients who began treatment at age 70 years, and as little as 3% for patients at age 30 years. Concl usion.-The cost-effectiveness of HMG-CoA reductase inhibitors varied w idely by age and sex and was sensitive to the presence of non-lipid CH D risk factors. The additional non-CHD costs due to increased life exp ectancy may be significant for the elderly, Accounting for the drug ef fects of raising HDL-C levels increased the proportion of the populati on for which medication treatment was relatively cost-effective.