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?

Cost-effective AlternatiCost-effective Treating Hypercholesterolemia

Bruce P. Kinosian, MD; John M. Eisenberg, MD, MBA

JAMA. 1988;259(15):2249-2254.

Abstract
We performed an analysis of the cost-effectiveness of treating individuals with significantly elevated levels of total serum cholesterol (>6.85 mmol/L [>265 mg/dL]), comparing treatment with three alternative agents: cholestyramine resin, colestipol, and oat bran (a soluble fiber). We simulated a program for lowering cholesterol levels that was similar to that of the Coronary Primary Prevention Trial, and then used the outcomes of the trial to calculate the incremental cost per year of life saved (YOLS) from the perspective of society. Our findings suggest that the cost per YOLS ranges from $117 17 400 (cholestyramine resin packets) to $70 900 (colestipol packets) and $17 800 (oat bran). Using bulk drug reduces the cost per YOLS to $65 100 (cholestyramine resin) and $63 900 (colestipol). Targeting bulk colestipol treatment only to smokers has a cost per YOLS of $47 010; the incremental cost of treating nonsmokers would be $89 600 per additional YOLS. Although pharmacologic therapy has substantial costs, it may be more cost-effective when low-cost forms are applied to particular high-risk groups, such as smokers. However, a broad public health approach to lowered cholesterol levels by additional dietary modification, such as with soluble fiber, may be preferred to a medically oriented campaign that focuses on drug therapy.

(JAMA 1988;259:2249-2254)

Author Affiliations
From the Division of General Medicine, Department of Medicine, University of Maryland, Baltimore (Dr Kinosian); the Section of General Medicine, Department of Medicine (Dr Eisenberg), and The Leonard Davis Institute of Health Economics (Drs Kinosian and Eisenberg), University of Pennsylvania, Philadelphia.

Footnotes
Reprint requests to Division of General Medicine, University of Maryland, 22 S Greene St, Box 151, Baltimore, MD (Dr Kinosian).

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Importance of Indirect Costs in Primary Cardiovascular Disease Prevention: Can We Save Lives and Money With Statins?
Grover et al.
Arch Intern Med 2003;163:333-339.
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  

Ineffective Secondary Prevention in Survivors of Cardiovascular Events in the US Population: Report From the Third National Health and Nutrition Examination Survey
Qureshi et al.
Arch Intern Med 2001;161:1621-1628.
ABSTRACT | FULL TEXT  

Lipid-Lowering Therapy in Low-Risk Patients
Pearson
JAMA 1998;279:1659-1661.
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  

Psyllium-Enriched Cereals Lower Blood Total Cholesterol and LDL Cholesterol, but Not HDL Cholesterol, in Hypercholesterolemic Adults: Results of a Meta-Analysis
Olson et al.
J. Nutr. 1997;127:1973-1980.
ABSTRACT | 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  

A Cost-effectiveness Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip
Chang et al.
JAMA 1996;275:858-865.
ABSTRACT  

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  

Cost and Outcome of Intensive Care for Patients With AIDS, Pneumocystis carinii Pneumonia, and Severe Respiratory Failure
Wachter et al.
JAMA 1995;273:230-235.
ABSTRACT  

Enthusiasm Misplaced?: Revisiting Cholesterol Screening
Oderkirk
J Holist Nurs 1994;12:414-424.
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  

Cost-effectiveness of a Routine Varicella Vaccination Program for US Children
Lieu et al.
JAMA 1994;271:375-381.
ABSTRACT  

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  

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 of HA-1A Monoclonal Antibody for Gram-Negative Sepsis: Economic Assessment of a New Therapeutic Agent
Schulman et al.
JAMA 1991;266:3466-3471.
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 Low-Dose Zidovudine Therapy for Asymptomatic Patients with Human Immunodeficiency Virus (HIV) Infection
Schulman et al.
ANN INTERN MED 1991;114:798-802.
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 Misoprostol for Prophylaxis Against Nonsteroidal Anti-inflammatory Drug--Induced Gastrointestinal Tract Bleeding
Edelson et al.
JAMA 1990;264:41-47.
ABSTRACT  

How to Evaluate Drugs: Cost-effectiveness Analysis
Beck
JAMA 1990;264:83-84.
ABSTRACT  

Economic Effects of Prophylactic Use of Misoprostol to Prevent Gastric Ulcer in Patients Taking Nonsteroidal Anti-inflammatory Drugs
Hillman and Bloom
Arch Intern Med 1989;149:2061-2065.
ABSTRACT  

Economics
Eisenberg
JAMA 1989;261:2840-2841.
ABSTRACT  

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

The Women's Health Trial as an Investment
Urban and Baker
Med Decis Making 1989;9:59-64.
ABSTRACT  

COST-EFFECTIVENESS OF CHOLESTEROL-REDUCTION MEASURES
JWatch General 1988;1988:8-8.
FULL TEXT