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Cost-Effectiveness of Cholesterol-Lowering Therapies according to Selected Patient Characteristics

Lisa A. Prosser, MS; Aaron A. Stinnett, PhD; Paula A. Goldman, MPH; Lawrence W. Williams, MSc; Maria G.M. Hunink, MD, PhD; Lee Goldman, MD, MPH; and Milton C. Weinstein, PhD
[+] Article and Author Information

From Harvard School of Public Health, Boston, Massachusetts; University of Alabama at Birmingham, Birmingham, Alabama; Erasmus University Medical School, Rotterdam, the Netherlands; and University of California, San Francisco, School of Medicine, San Francisco, California.


Disclosure: The Harvard Program on the Economic Evaluation of Medical Technology has received funding from Merck (unrestricted funds, unrelated to cholesterol-lowering drugs). Drs. Weinstein and Goldman were co-investigators for the economic substudy of the CARE study of pravastatin funded by Bristol-Myers Squibb.

Grant Support: By grant R01 HS 06258 from the Agency for Healthcare Research and Quality, unrestricted funds from the Harvard Program on the Economic Evaluation of Medical Technology (Ms. Prosser), National Library of Medicine Training Grant 5T15LM07092-08 (Ms. Prosser), and a Faculty Development Award in Pharmacoeconomics from the Pharmaceutical Research and Manufacturers of America Foundation (Dr. Stinnett).

Requests for Single Reprints: Milton C. Weinstein, PhD, Harvard Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115-5924.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Ms. Prosser: Department of Ambulatory Care and Prevention, Harvard Medical School, 126 Brookline Avenue, Boston, MA 02215.

Dr. Stinnett: University of Alabama at Birmingham, 330 RPHB, Birmingham, AL 35294-0022.

Ms. Goldman, Mr. Williams, and Dr. Weinstein: Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115-5924.

Dr. Hunink: Erasmus Medical Center, Box 1738, 3000 DR Rotterdam, the Netherlands.

Dr. Goldman: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Author Contributions: Conception and design: L. Prosser, A.A. Stinnett, M.C. Weinstein.

Analysis and interpretation of the data: L. Prosser, P.A. Goldman, M.C. Weinstein.

Drafting of the article: L. Prosser.

Critical revision of the article for important intellectual content: P.A. Goldman, M.G.M. Hunink, L. Goldman, M.C. Weinstein.

Final approval of the article: L. Prosser, A.A. Stinnett, P.A. Goldman, L.W. Williams, M.G.M. Hunink, L. Goldman, M.C. Weinstein.

Obtaining of funding: M.C. Weinstein.

Administrative, technical, or logistic support: P.A. Goldman, L.W. Williams.

Collection and assembly of data: L. Prosser, P.A. Goldman.


Ann Intern Med. 2000;132(10):769-779. doi:10.7326/0003-4819-132-10-200005160-00002
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Several large-scale, long-term clinical trials evaluating statin drugs (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) have confirmed the beneficial effect of reducing cholesterol levels on coronary event rates and related mortality (15). Statin drugs are expensive, especially considering the large number of persons who could potentially benefit from cholesterol-lowering therapies. As a result, many analyses have focused on the costs, resource use, and cost-effectiveness of using statins to lower cholesterol levels (615).

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Figures

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Figure 1.
Cost-effectiveness of primary prevention with diet in men (top) and women (bottom) with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (≥ 160 mg/dL).RFsPF

Squares represent results of the base-case analysis for cost-effectiveness by age and sex without considering additional risk factors. Bars represent the range of cost-effectiveness by age group once selected additional risk factors are considered. The number of risk factors per subgroup ranged from no risk factors ( ) or one protective factor ( ) to three or four risk factors per subgroup. QALY = quality-adjusted life-year.

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Figure 2.
Cost-effectiveness of primary prevention with pravastatin in men (top) and women (bottom) with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (≥ 160 mg/dL).RFsPF

Squares represent results of the base-case analysis for cost-effectiveness by age and sex without considering additional risk factors. Bars represent range of cost-effectiveness by age group once selected additional risk factors are considered. The number of risk factors per subgroup ranged from no risk factors ( ) or one protective factor ( ) to three or four risk factors per subgroup. QALY = quality-adjusted life-year.

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Summary for Patients

The Cost Effectiveness of Lowering Cholesterol in Individual Patients

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.

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