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Economic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidence.

Abstract：

STUDY OBJECTIVE:To investigate and evaluate published data on cost effectiveness of cholesterol lowering interventions, and how this information could be interpreted in a rational approach of cholesterol management in general practice. DESIGN:A systematic review of the literature. SETTING:No restriction on setting. MATERIALS:Papers reporting on the cost effectiveness or cost utility of prevention of (recurrent) coronary heart disease by reduction of hypercholesterolaemia in adults. MAIN RESULTS:Thirty nine studies, most cost effectiveness analyses, were included. In 24 studies drug interventions only were analysed. Costs of screening to target cholesterol lowering interventions to persons with hypercholesterolaemia were considered in nine studies. Adjustments of the efficacy of the intervention for community effectiveness were described in seven studies. In four studies life years gained were adjusted for quality of life. Despite large variation in the outcomes, there is a constant tendency towards a less favourable cost effectiveness ratio for intervening in persons without coronary heart disease compared with persons with coronary heart disease and for women compared with men. CONCLUSIONS:There is lack of data on cost effectiveness of cholesterol lowering interventions in the general practice setting. The cost effectiveness of cholesterol lowering in general practice deteriorates when all relevant costs are taken into account and when efficacy is corrected for community effectiveness. Cholesterol lowering intervention is more cost effective in men compared with women and in patients with coronary heart disease compared with persons without coronary heart disease. Considerations from cost effectiveness analyses should be incorporated into the development and implementation of national cholesterol guidelines for general practitioners. Standardisation of cost effectiveness studies is important for future economic evaluations.

journal_name

J Epidemiol Community Health

journal_title

Journal of epidemiology and community health

authors

van der Weijden T,Knottnerus JA,Ament AJ,Stoffers HE,Grol RP

doi

10.1136/jech.52.9.586

keywords:

subject

Has Abstract

pub_date

1998-09-01 00:00:00

pages

586-94

issue

eissn

0143-005X

issn

1470-2738

journal_volume

pub_type

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Economic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidence.