Resource utilisation in the management of dyslipidaemia

In Western countries, cardiovascular disease accounts for substantial morbi dity and mortality. In the US, where medical costs and intervention rates a re the highest in the world, the direct and indirect costs of cardiovascula r disease and stroke have been estimated at $US274 billion (1998 dollars), with the costs of hospitalisation ($US 119.9 billion) and lost productivity because of early mortality ($US77.9 billion) representing the largest prop ortions of this amount. Dyslipidaemia is an important risk factor for coron ary heart disease (CHD), a condition which accounts for $US39.3 billion and $US37.9 billion (1998 dollars) in hospitalisation/nursing home costs and l ost productivity, respectively, annually in the US. Similarly, the UK Natio nal Health Service spends more than 500 million pounds sterling annually on the treatment of CHD. Numerous studies have shown the benefit of lowering cholesterol levels in t erms of decreasing CHD-associated morbidity and mortality; however, drug th erapy costs for dyslipidaemia can be high. US and European treatment guidel ines for dyslipidaemia recommend aggressive treatment for those at highest CHD event risk. Because of the high prevalence of dyslipidaemia in Western countries, these recommendations impact on a substantial proportion of the population and have increased the use of cholesterol-lowering medications. In a limited number of economic studies using clinical data from large prev ention trials, the cost of drug therapy was nearly offset by the reduction in costs associated with hospitalisations and revascularisation procedures. Therefore, it appears that the strategy of identifying and treating indivi duals at highest risk for CHD, although expensive in terms of drug costs, w ould be expected to reduce the substantial direct and indirect costs associ ated with this condition.