Cost-effectiveness analysis in long-term treatment of risk factors

Health care decision makers are increasingly forced to identify and impleme nt the options for potential spendings and savings. Historically, preventiv e measures for cardiovascular diseases have been scrutinised a great deal. The main reason for this was that substantial financial investments would h ave to be undertaken long before the clinical benefits were apparent. In th e past, most economic evaluations of lipid lowering therapy have been based on models combining logistic regression risk functions from epidemiologica l cohort studies, such as the Framingham study, with the extent of choleste rol reduction. Recently, however, data from the large controlled outcome st udies (4S, CARE, LIPID, WOSCOPS) have been reported which allow a direct es timate of the economic benefits of cholesterol reduction in primary) and se condary prevention. The economic evaluation of such therapies can be perfor med in several ways, from relatively easy cost-consequence analyses to more complex cost-effectiveness analysis. Initial economic analyses of the tria ls are already available. There are, however, still considerable practical and methodological issues which have to be taken into account in assessing lipid lowering drugs. Available pharmaco-economic data on lipid lowering th erapies suggest chat statins are a cost-effective option in primary and sec ondary coronary prevention.