This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

The Case of Cholestyramine

Gerry Oster, PhD; Arnold M. Epstein, MD, MA

JAMA. 1987;258(17):2381-2387.

Abstract
Using cholestyramine as a model, we considered the cost-effectiveness of antihyperlipemic therapy in the primary prevention of coronary heart disease among men between 35 and 74 years of age with elevated levels of total plasma cholesterol. Our findings indicate that the cost-effectiveness of treatment varies substantially, ranging from about $36 000 to over $1 million per year of life saved. Cost-effectiveness was highest for younger patients, for those with additional coronary risk factors (eg, smoking or hypertension), and for those whose course of therapy is of less-than-lifelong duration. Conversely, it is lowest for older patients, for those with no additional coronary risk factors, and for those who are treated for a lifetime. Our results suggest that pharmacologic therapy may not be cost-effective for all patients with elevated cholesterol levels, especially those over 65 years of age. For many younger patients, however—those with additional coronary risk factors and more severe elevations in cholesterol levels—the cost-effectiveness of therapy may be comparable with other accepted medical practices.

(JAMA 1987;258:2381-2387)

Author Affiliations
From Policy Analysis Inc, Brookline, Mass (Dr Oster), and the Department of Medicine (Division of General Medicine), Brigham and Women's Hospital and Harvard Medical School and the Institute for Health Research, a Joint Program of Harvard Community Health Plan and Harvard University, Boston (Dr Epstein). Dr Epstein is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Footnotes
Reprint requests to Policy Analysis Inc, 1577 Beacon St, Brookline, MA 02146 (Dr Oster).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Expanded HIV Screening in the United States: Effect on Clinical Outcomes, HIV Transmission, and Costs
Paltiel et al.
ANN INTERN MED 2006;145:797-806.
ABSTRACT | FULL TEXT  

Effectiveness of radiation therapy for older women with early breast cancer.
Smith et al.
JNCI J Natl Cancer Inst 2006;98:681-690.
ABSTRACT | FULL TEXT  

Task Force #2--the cost of prevention: can we afford it? Can we afford not to do it?
Krumholz et al.
J Am Coll Cardiol 2002;40:603-615.
FULL TEXT  

Estimating the Benefits of Modifying Risk Factors of Cardiovascular Disease: A Comparison of Primary vs Secondary Prevention
Grover et al.
Arch Intern Med 1998;158:655-662.
ABSTRACT | FULL TEXT  

Treating Hyperlipidemia for the Primary Prevention of Coronary Disease: Are Higher Dosages of Lovastatin Cost-effective?
Perreault et al.
Arch Intern Med 1998;158:375-381.
ABSTRACT | FULL TEXT  

Users' Guides to the Medical Literature: XIII. How to Use an Article on Economic Analysis of Clinical Practice A. Are the Results of the Study Valid?
Drummond et al.
JAMA 1997;277:1552-1557.
ABSTRACT  

Guidelines for authors and peer reviewers of economic submissions to the BMJ
Drummond and Jefferson
BMJ 1996;313:275-283.
FULL TEXT  

Cholesterol Lowering and the Use of Healthcare Resources : Results of the Scandinavian Simvastatin Survival Study
Pedersen et al.
Circulation 1996;93:1796-1802.
ABSTRACT | FULL TEXT  

Cholesterol-Reduction Intervention Study (CRIS) A Randomized Trial to Assess Effectiveness and Costs in Clinical Practice
Oster et al.
Arch Intern Med 1996;156:731-739.
ABSTRACT  

Discontinuation of Antihyperlipidemic Drugs -- Do Rates Reported in Clinical Trials Reflect Rates in Primary Care Settings?
Andrade et al.
NEJM 1995;332:1125-1131.
ABSTRACT | FULL TEXT  

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study
Grover et al.
BMJ 1995;310:975-978.
ABSTRACT | FULL TEXT  

The Cost-effectiveness of HMG-CoA Reductase Inhibitors to Prevent Coronary Heart Disease: Estimating the Benefits of Increasing HDL-C
Hamilton et al.
JAMA 1995;273:1032-1038.
ABSTRACT  

Dietitian Practices for Adult Outpatients With Hypercholesterolemia Referred by Physicians: The Minnesota Dietitian Survey
Elson et al.
Arch Fam Med 1994;3:1073-1080.
ABSTRACT  

Designing a Simpler High Blood Cholesterol Case Detection Strategy: Are the Advantages of the NCEP Protocol Worth the Complexity?
Hofer and Weissfeld
Med Decis Making 1994;14:357-368.
ABSTRACT  

Setting Limits in Clinical Medicine
Murphy et al.
Arch Intern Med 1994;154:505-512.
ABSTRACT  

Evaluating Drugs after Their Approval for Clinical Use
Ray et al.
NEJM 1993;329:2029-2032.
FULL TEXT  

Combination Drug Therapy for Hypercholesterolemia: The Trade-off Between Cost and Simplicity
Heudebert et al.
Arch Intern Med 1993;153:1828-1837.
ABSTRACT  

Selection of End Points in Economic Evaluations of Coronary-heart-disease Interventions
Drummond et al.
Med Decis Making 1993;13:184-190.
ABSTRACT  

Should We Be Measuring Blood Cholesterol Levels in Young Adults?
Hulley et al.
JAMA 1993;269:1416-1419.
ABSTRACT  

The Benefits of Treating Hyperlipidemia to Prevent Coronary Heart Disease: Estimating Changes in Life Expectancy and Morbidity
Grover et al.
JAMA 1992;267:816-822.
ABSTRACT  

Cost-Effectiveness and Cost-Benefit Analyses in the Medical Literature: Are the Methods Being Used Correctly?
Udvarhelyi et al.
ANN INTERN MED 1992;116:238-244.
ABSTRACT  

Comparison of an Aggressive (U.S.) and a Less Aggressive (Canadian) Policy for Cholesterol Screening and Treatment
Krahn et al.
ANN INTERN MED 1991;115:248-255.
ABSTRACT  

Guidelines for the Detection and Treatment of Elevated Serum Cholesterol: Which Is the Baby and Which Is the Bathwater?
Pearson
ANN INTERN MED 1991;115:324-326.
ABSTRACT  

Should the Elderly Be Screened for Hypercholesterolemia?
Eisenberg
Arch Intern Med 1991;151:1063-1065.
ABSTRACT  

Cost-effectiveness of HMG-CoA Reductase Inhibition for Primary and Secondary Prevention of Coronary Heart Disease
Goldman et al.
JAMA 1991;265:1145-1151.
ABSTRACT  

Reducing High Blood Cholesterol Level With Drugs: Cost-effectiveness of Pharmacologic Management
Schulman et al.
JAMA 1990;264:3025-3033.
ABSTRACT  

Cost Effectiveness of Screening Perimenopausal White Women for Osteoporosis: Bone Densitometry and Hormone Replacement Therapy
Tosteson et al.
ANN INTERN MED 1990;113:594-603.
ABSTRACT  

Are Clinical Trials a Cost-effective Investment?
Detsky
JAMA 1989;262:1795-1800.
ABSTRACT  

Cholesterol Lowering for All: A Closer Look
Palumbo
JAMA 1989;262:91-92.
ABSTRACT  

Screening Asymptomatic Adults for Cardiac Risk Factors: The Serum Cholesterol Level
Garber et al.
ANN INTERN MED 1989;110:622-639.
ABSTRACT  

The Cost-effectiveness of Counseling Smokers to Quit
Cummings et al.
JAMA 1989;261:75-79.
ABSTRACT  

Cutting Into Cholesterol: Cost-effective AlternatiCost-effective Treating Hypercholesterolemia
Kinosian and Eisenberg
JAMA 1988;259:2249-2254.
ABSTRACT  

Cost-effectiveness of Antihyperlipemic Therapy
Klevay
JAMA 1988;259:1811-1811.
ABSTRACT  

COST-EFFECTIVENESS OF TREATING HIGH CHOLESTEROL
JWatch General 1987;1987:7-7.
FULL TEXT  

A Prudent Approach to Control of Cholesterol Levels
Fihn
JAMA 1987;258:2416-2418.
ABSTRACT