The Cost Effectiveness of Lowering Cholesterol in Individual Patients

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The summary below is from the full report titled "Cost-Effectiveness of Cholesterol-Lowering Therapies according to Selected Patient Characteristics". It is in the 16 May 2000 issue of Annals of Internal Medicine (volume 132, pages 769-779). The authors are L.A. Prosser, A.A. Stinnett, P.A. Goldman, L.W. Williams, M.G.M. Hunink, L. Goldman, and M.C. Weinstein.

What is the problem and what is known about it so far?

National guidelines recommend cholesterol-lowering treatment on the basis of an individual patient's cholesterol levels and risk factors for heart disease. However, using drugs to lower cholesterol levels is expensive. It is unclear for which types of patients this cost is worth the benefit. Statins are the major type of medicines used to lower cholesterol levels.

Why did the researchers do this particular study?

The researchers wanted to find out how the costs and benefits of cholesterol-lowering therapy vary with individual patient risk factors, including age, sex, smoking, blood pressure, and levels of "good" (high-density lipoprotein, or HDL) and "bad" (low-density lipoprotein, or LDL) cholesterol.

Who was studied?

The researchers used computers to simulate what would happen to a "virtual" group of 35- to 84-year-old patients who had high LDL cholesterol levels (at least 160 mg/dL, or 4.1 mmol/L).

How was the study done?

The authors divided the virtual patients into 240 separate groups according to various combinations of cholesterol level and other risk factors. They used information from actual patients to estimate what might happen when each group of patients was treated with diet alone, received statin drugs, or received no cholesterol-lowering treatment. They measured how much a particular treatment approach would cost for each additional quality-adjusted life-year (QALY) it saves. The QALYs take into account how well people are during those years.

What did the researchers find?

Compared with no treatment, the costs of diet alone seemed nearly always worth the benefit, except perhaps for women 35 to 44 years of age who had no risk factors. The costs of using statin drugs to treat patients who had already had a heart attack (secondary prevention) was always less than $50,000 per QALY saved, which compares favorably with the costs of many other accepted health interventions. The costs of lowering cholesterol levels with statin drugs in persons who had few risk factors and had not already had a heart attack (primary prevention) were, however, very high; they were greater than $100,000 per QALY in younger men and up to $1,400,000 per QALY in younger women.

What were the limitations of the study?

This study was a computer simulation. We cannot be sure what the results would be with actual patients. These estimates can be useful, however, because studies of this problem using actual patients are unlikely to be done soon, if ever. The findings may not apply to patients younger than 35 or older than 84 years of age and to cholesterol-lowering drugs other than statins.

What are the implications of the study?

For people who have already had a heart attack, the benefits associated with statin drugs appear to be worth the costs. However, among those who have not had a heart attack, the cost-effectiveness of statin drugs varies greatly depending on the risk factors present in each patient.