Cost-effectiveness of cholesterol-lowering therapies according to selectedpatient characteristics

Background: The National Cholesterol Education Program Expert Panel on Dete ction, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) recommends treatment guidelines based on cholesterol l evel and number of risk factors. Objective: To evaluate how the cost-effectiveness ratios of cholesterol-low ering therapies vary according to different risk factors. Design: Cost-effectiveness analysis. Data Sources: Published data. Target Population: Women and men 35 to 84 years of age with low-density lip oprotein cholesterol levels of 4.1 mmol/L or greater (greater than or equal to 160 mg/dL), divided into 240 risk subgroups according to age, sex, and the presence or absence of four coronary heart disease risk factors (smokin g status, blood pressure, low-density lipoprotein cholesterol level, and hi gh-density lipoprotein cholesterol level). Time Horizon: 30 years. Perspective: Societal. Interventions: Step I diet, statin therapy, and no preventive treatment for primary and secondary prevention. Outcome Measures: Incremental cost-effectiveness ratios. Results of Base-Case Analysis: Incremental cost-effectiveness ratios for pr imary prevention with step I diet ranged from $1900 per quality-adjusted li fe-year (QALY) gained to $500 000 per QALY depending on risk subgroup chara cteristics. Primary prevention with a statin compared with diet therapy was $54 000 per QALY to $1 400 000 per QALY. Secondary prevention with a stati n cost less than $50 000 per QALY for all risk subgroups. Results of Sensitivity Analysis: The inclusion of niacin as a primary preve ntion option resulted in much less favorable incremental cost-effectiveness ratios for primary prevention with a statin (>$500 000 per QALY). Conclusions: Cost-effectiveness of treatment strategies varies significantl y when adjusted for age, sex, and the presence or absence of additional ris k factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but may not be cost-effective for otherwise health y young women. Primary prevention with a statin may not be cost-effective f or younger men and women with few risk factors, given the option of seconda ry prevention and of primary prevention in older age ranges. Secondary prev ention with a statin seems to be cost-effective for all risk subgroups and is cost-saving in some high-risk subgroups.