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The cost effectiveness of lipid lowering in Swedish primary health care. The CELL Study Group
M Johannesson1, L Borgquist, B Jönsson
1Central for Health Economics, Stockholm School of Economics, Sweden.
Insights
Intensive advice for lowering cardiovascular risk is not cost-effective compared to lipid-lowering drugs. Drug treatment for primary prevention may also not be cost-effective for this patient group.
Area of Science:
- Cardiovascular disease prevention
- Health economics
- Primary care research
Background:
- Cardiovascular risk factors necessitate effective and economical interventions.
- Evaluating the cost-effectiveness of lifestyle advice versus pharmacological treatment is crucial for public health resource allocation.
Purpose of the Study:
- To assess the cost-effectiveness of intensive versus usual advice for cardiovascular risk reduction.
- To compare these strategies with and without cholesterol-lowering pharmacological medication.
Main Methods:
- A 18-month prospective, randomized, controlled clinical study involving 355 males aged 30-59 years with hyperlipidemia.
- Interventions included intensive group advice, usual advice, and pravastatin for pharmacological treatment.
- Cost-effectiveness was measured as cost per life-year gained.
Main Results:
- Intensive advice combined with pharmacological treatment showed no incremental benefits over usual advice.
- Pharmacological treatment was more cost-effective than intensive advice alone.
- The cost per life-year gained for pharmacological treatment versus no treatment was approximately $61,000.
Conclusions:
- Intensive advice is not a cost-effective strategy compared to lipid-lowering drug treatment.
- The cost-effectiveness of drug treatment as primary prevention in this population remains uncertain.
Objective:
To evaluate the cost-effectiveness of two types of advice (usual and intensive) to lower cardiovascular risk, with or without pharmacological medication aimed at lowering cholesterol levels.
Design:
Prospective, randomized, controlled clinical study of 18 months' duration.
Setting:
Thirty-two primary health care centres in Sweden.
Subjects:
A total of 384 males, aged 30-59 years, with at least one cardiovascular risk factor in addition to moderate primary hyperlipidaemia; of these, 355 completed the 18-month follow-up.
Interventions:
Intensive advice consisted of group sessions led by a health care professional; the usual level of advice was given at follow-up visits. The pharmacological intervention consisted of pravastatin. The goal was to achieve a 15% reduction in cholesterol.
Main Outcome Measures:
Cost per life-year gained based on the change in serum cholesterol and the net intervention cost of the four treatment options.
Results:
The usual level of advice and intensive advice in combination with pharmacological treatment achieved no incremental effects and were not considered in the cost-effectiveness analysis. The cost per life-year gained of pharmacological treatment compared with intensive advice decreased. The cost per life-year gained of pharmacological treatment compared with no treatment was about $61,000, if no adverse consequences on noncardiovascular mortality were assumed.
Conclusions:
According to the results of the CELL trial, intensive advice is not a cost-effective strategy compared with lipid-lowering drug treatment. However, it is also doubtful whether drug treatment as primary prevention is cost-effective compared with no treatment in the studied patient population.