Resource utilisation in the management of dyslipidaemia

In Western countries, cardiovascular disease accounts for substantial morbidity and mortality. In the US, where medical costs and intervention rates are the highest in the world, the direct and indirect costs of cardiovascular disease and stroke have been estimated at $US274 billion (1998 dollars), with the costs of hospitalisation ($US119.9 billion) and lost productivity because of early mortality ($US77.9 billion) representing the largest proportions of this amount. Dyslipidaemia is an important risk factor for coronary heart disease (CHD), a condition which accounts for $US39.3 billion and $US37.9 billion (1998 dollars) in hospitalisation/nursing home costs and lost productivity, respectively, annually in the US. Similarly, the UK National Health Service spends more than 500 million pounds sterling annually on the treatment of CHD. Numerous studies have shown the benefit of lowering cholesterol levels in terms of decreasing CHD-associated morbidity and mortality; however, drug therapy costs for dyslipidaemia can be high. US and European treatment guidelines for dyslipidaemia recommend aggressive treatment for those at highest CHD event risk. Because of the high prevalence of dyslipidaemia in Western countries, these recommendations impact on a substantial proportion of the population and have increased the use of cholesterol-lowering medications. In a limited number of economic studies using clinical data from large prevention trials, the cost of drug therapy was nearly offset by the reduction in costs associated with hospitalisation and revascularisation procedures. Therefore, it appears that the strategy of identifying and treating individuals at highest risk for CHD, although expensive in terms of drug costs, would be expected to reduce the substantial direct and indirect costs associated with this condition.