Cost-effectiveness of hypolipidaemic drugs

Prevention of coronary heart disease involves intervention at both the population and the individual level. These procedures are complementary. Opportunistic screening and management of hypercholesterolaemia in general practice is an efficient procedure. Calculations show that the cost of each quality adjusted year of life saved by such an opportunistic approach compares favourably with that of other approaches to coronary heart disease treatment as well as other coronary prevention programmes. Cost-effectiveness is greater in those with existing coronary heart disease but lower for the treatment of younger patients. This presentation considers the relative costs of drug treatment in relation to cholesterol reduction, but emphasizes that high density lipoprotein cholesterol and triglyceride levels must also be considered. Cholesterol management should form part of a multiple risk factor assessment with priority for those at high overall risk. Active dietary intervention should be offered to all patients, with drug treatment reserved for a small minority. The choice of drug treatment should depend on the required cholesterol reduction, the pattern of hyperlipidaemia and the cost of treatment.