MAXIMIZING THE COST-EFFECTIVENESS OF LIPID-LOWERING THERAPY

Cardiovascular disease, including coronary heart disease, is the leadi ng cause of death both in men and in women in the United States. The p urpose of this review is to describe the effectiveness of lipid-loweri ng therapy in reducing cardiovascular morbidity and mortality, which h as recently been extended to patients with mild to moderate hyperchole sterolemia, and the cost of providing therapy, which would be prohibit ive if all persons with hypercholesterolemia received treatment. Cost- effectiveness analysis provides a rational means of allocating limited health care resources by allowing the comparison of the costs of lipi d-lowering therapy, in particular, therapy with beta-hydroxy-beta-meth ylglutaryl-CoA (coenzyme A) reductase inhibitors (statins), with the c osts of atherosclerosis that could be prevented by lowering cholestero l. To extend the benefits of treatment to the large number of persons not receiving therapy, we need to implement more cost-effective treatm ent by improving risk assessment, increasing treatment effectiveness, and reducing the cost of therapy.