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European Heart Journal 2001 22(11):919-925; doi:10.1053/euhj.2000.2484
Copyright © 2001 by the European Society of Cardiology.
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At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention?

M Johannessonf1

Centre for Health Economics, Stockholm School of Economics, Stockholm, Sweden

revised September 22, 2000; accepted October 4, 2000

Abstract

Background The entire risk factor profile should be taken into account when considering initiating cholesterol lowering drug treatment. Recent treatment guidelines are therefore based on the absolute risk of coronary heart disease. We estimated at what coronary risk it is cost-effective to initiate cholesterol lowering drug treatment in primary prevention for men and women of different ages in Sweden.

Methods The cost-effectiveness was estimated as the incremental cost per quality-adjusted life-year (QALY) gained of cholesterol lowering drug treatment. Treatment was assumed to lower the risk of coronary heart disease by 31%. The analysis was carried out from a societal perspective including both direct and indirect costs of the intervention and morbidity, and the full future costs of decreased mortality. The coronary risk, in a Markov model of coronary heart disease, was raised until the cost per QALY gained corresponded to a specific threshold value per QALY gained. Three different threshold values were used: $40000, $60000 and $100000 per QALY gained.

Results The risk cut-off value for when treatment is cost-effective varied with age and gender. If society is willing to pay $60000 to gain a QALY it was cost-effective to initiate treatment if the 5-year-risk of coronary heart disease exceeded 2·4% for 35-year-old men, 4·6% for 50-year-old men, and 10·4% for 70-year-old men. The corresponding risk cut-off values for women were 2·0%, 3·5% and 9·1%.

Conclusions The results can serve as a basis for treatment guidelines based on cost-effectiveness.

Key Words: Cholesterol, cost-effectiveness, coronary heart disease, primary prevention

f1 Correspondence: Magnus Johannesson, PhD, Centre for Health Economics, Stockholm School of Economics, Box 6501, S-113 83 Stockholm, Sweden.

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