Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-01T12:07:12.968Z Has data issue: false hasContentIssue false

A Model for Evaluating the Cost-Effectiveness of Cholesterol-Lowering Treatment

Published online by Cambridge University Press:  10 March 2009

Henry Glick
Affiliation:
University of Pennsylvania
Joseph F. Heyse
Affiliation:
Merck Laboratories
David Thompson
Affiliation:
Policy Analysis Inc.
Robert S. Epstein
Affiliation:
University of Maryland and Merck Research Laboratories
M. Eugene Smith
Affiliation:
Merck & Co.Inc.
Gerry Oster
Affiliation:
Policy Analysis Inc.

Abstract

We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Abbott, R. D., & McGee, D. Section 37: The probability of developing certain cardiovascular diseases in eight years at specified values of some characteristics. In Kannell, W. B., Woolf, P. A., & Garrison, R. J. (eds.), The Framingham Study. An epidemiological investigation of cardiovascular disease. U.S. Dept. of Health, Education, and Welfare publication NIH 87–2703. Bethesda, MD: Public Health Service, 1987.Google Scholar
2.Berwick, D. M., Cretin, S., & Keeler, E.Cholesterol, children, and heart disease: An analysis of alternatives. New York: Oxford University Press Inc., 1980.Google Scholar
3.The Expert Panel. Report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Archives of Internal Medicine, 1988, 148, 3669.Google Scholar
4.Hay, J. W., Wittels, E. H., & Gotto, A. M. Jr.An economic evaluation of lovastatin for cholesterol lowering and coronary artery disease reduction. American Journal of Cardiology, 1991, 67, 789–96.Google Scholar
5.Hunninghake, D. B. Clinical trials of lovastatin and simvastatin versus cholestyramine. In Stokes, J. & Mancini, M. (eds.), Hypercholesterolemia: Clinical and therapeutic implications (Atherosclerosis Reviews v. 18). New York: Raven Press, 1988, 133–38.Google Scholar
6.Kinosian, B. P., & Eisenberg, J. M.Cutting into cholesterol: Cost-effective alternatives for treating hypercholesterolemia. Journal of the American Medical Association, 1988, 259, 2249–54.CrossRefGoogle ScholarPubMed
7.Leaverton, P. E., Sorlie, P.D., Kleinman, J. C., et al. Representativeness of the Framingham risk model for coronary heart disease mortality: A comparison with a national cohort study. Journal of Chronic Diseases, 1987, 40(8), 775–84.CrossRefGoogle ScholarPubMed
8.Lipid Research Clinics Program. The Lipid Research Clinic Coronary Primary Prevention Trial results: I. Reduction in the incidence of coronary heart disease. Journal of the American Medical Association, 1984, 251, 351–64.CrossRefGoogle Scholar
9.Lipid Research Clinics Program. The Lipid Research Clinic Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. Journal of the American Medical Association, 1984, 251, 365–74.Google Scholar
10.National Center for Health Statistics. Health of the United States, 1987. DHHS Pub. No. (PHS) 88–1232. Public Health Service. Washington, DC: U. S. Government Printing Office, 1988.Google Scholar
11. National Center for Health Statistics, Hadden, W. C., & Harris, M.I.Prevalence of diagnosed diabetes, undiagnosed diabetes, and impaired glucose tolerance in adults 20– 74 years of age, United States, 1976–1980. Vital and Health Statistics. Series 11, No. 237, DHHS Pub. No. (PHS) 87–1687. Public Health Service. Washington, DC: U. S. Government Printing Office, 1987.Google Scholar
12. National Center for Health Statistics, Drizd, T., Dannenberg, A. L., & Engel, A. Y.Blood pressure levels in persons 18–74 years of age in 1976–1980, and trends in blood pressure from 1960 to 1980 in the United States. Vital and Health Statistics. Series 11, No. 234, DHHS Pub. No. (PHS) 86–1684. Public Health Service. Washington, DC: U. S. Government Printing Office, 1986.Google Scholar
13.Oster, G., & Epstein, A. M.Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease: The case of cholestyramine. Journal of the American Medical Association, 1987, 258, 2381–87.Google Scholar
14.Oster, G., & Epstein, A. M.Primary prevention and coronary heart disease: The economic benefits of lowering serum cholesterol. American Journal of Public Health, 1986, 76, 647–56.CrossRefGoogle ScholarPubMed
15.Sempos, C., Fulwood, R., Haines, C., et al. The prevalence of high blood cholesterol levels among adults in the United States. Journal of the American Medical Association, 1989, 262, 4552.Google Scholar
16.Sorlie, P. Section 32: Cardiovascular diseases and death following myocardial infarction and angina pectoris: Framingham study, 20-year follow-up. Kannel, W. B., Gordon, T. (eds.), The Framingham study: An epidemiological investigation of cardiovascular disease. U. S. Dept. of Health, Education, and Welfare publication (NIH) 77–1247. Bethesda, MD: Public Health Service, 1977.Google Scholar
17.Taylor, W. C., Pass, T. M., Shepherd, D. S., & Komeroff, A. L. Cost-effectiveness of cholesterol reduction for the primary prevention of coronary heart disease in men. From an un published cost-effectiveness background paper for the United States Preventive Services Task Force (USPSTF). 02 1988.Google Scholar
18.Vital Statistics of the United States, 1986. U. S. Dept. of Health and Human Services publication (PHS) 88–1147. Hyattsville, MD: National Center in Health Statistics, 1988.Google Scholar
19.Weinstein, M.C., & Stason, W. B.Cost-effectiveness of interventions to prevent or treat coronary heart disease. Annual Review of Public Health, 1985, 6, 4163.Google Scholar