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Cost-effectiveness of Pharmacologic Management

Kevin A. Schulman, MD; Bruce Kinosian, MD; Terry A. Jacobson, MD; Henry Glick, MA; Mary Kaye Willian, DrPH, RN; Harris Koffer, PharmD; John M. Eisenberg, MD

JAMA. 1990;264(23):3025-3033.

Abstract
We performed a cost-effectiveness analysis of pharmacologic treatment of high blood cholesterol levels. Agents modeled were cholestyramine, colestipol, gemfibrozil, lovastatin, niacin, and probucol. Pharmacologic effectiveness was estimated from reported studies. Cost estimates reflect societal resource consumption. Annual costs for therapy ranged from $327 (niacin) to $1881 (lovastatin, 80 mg/d). Niacin was the most efficient agent for reducing low-density lipoprotein cholesterol levels, having an average cost over 5 years of $139 per percent reduction in low-density lipoprotein cholesterol level. Lovastatin (20 mg/d) was also efficient ($177 per percent reduction). Cholestyramine was least efficient at $347. For high-density lipoprotein cholesterol, niacin was most efficient, at $116 per percent increase in high-density lipoprotein cholesterol level, followed by gemfibrozil at $271. Analyses combining low-density lipoprotein cholesterol and high-density lipoprotein cholesterol effects suggest that niacin and lovastatin (20mg/d) were most efficient for reducing cardiovascular risk.

(JAMA. 1990;264:3025-3033)

Author Affiliations
From the Department of Medicine (Dr Schulman), Section of General Internal Medicine (Drs Kinosian, Jacobson, and Eisenberg and Mr Glick), Robert Wood Johnson Foundation Clinical Scholars Program (Dr Jacobson), and Leonard Davis Institute of Health Economics (Drs Kinosian and Eisenberg and Mr Glick), University of Pennsylvania, Philadelphia; Philadelphia Veterans Affairs Medical Center (Drs Kinosian and Jacobson); and the Philadelphia Association for Clinical Trials (Drs Willian and Koffer).

Footnotes
Reprint requests to Program in Geriatric Medicine, Section of General Internal Medicine, Ralston-Penn Center, 3615 Chestnut St, Philadelphia, PA 19104-4283 (Dr Kinosian).

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