[Cost-effectiveness of pharmacologic treatments for the reduction of blood lipids]

Abstract

Background: The cost-effectiveness of hypolipemiant treatment with lovastatine (0.02, 0.04 and 0.08 g/day), cholestyramine (12 and 24 g/day), cholestipol (10 and 20 g/day) and gemfibrocyl (1.2 g/day) was estimated in individuals presenting hypercholesterolemia (> 200 mg/dl or 5.17 mmol/l) following dietetic treatment.

Methods: The cost-effectiveness relationship was measured in terms of cost per year of life gained comparing the net cost of the program with its effectiveness for each treatment studied. The net cost of the program was calculated taking the costs associated with hypolipemiant treatment into account and subtracting the estimated reduction of the costs of coronary heart disease attributed to the prevention program. The Framingham equation and the information concerning to the prevalence of cardiovascular risk factors and life expectancy according to age and sex in the Catalonian (Spain) population were used to estimate the effectiveness.

Results: The lesser to greater cost per year of life gained is lovastatine-0.02, cholestyramine-12, cholestipol-12, lovastatine-0.04, gemfibrocyl, cholestyramine-24, cholestipol-10, lovastatine-0.08 and cholestipol-20. In males from 45-49 years of age with cholesterol concentration of 300 mg/dl (7.76 mmol/l) the costs per year of life gained were 3.4 millions for lovastatine-0.02, 4.6 for cholestyramine-12, 4.8 for lovastatine-0.04, 5.4 for gemfibrocyl, 6.5 for cholestyramine-24, 7.8 for cholestipol-10, 8.1 for lovastatine 0.08 and 11.6 for cholestipol-20. In women the cost-effectiveness were 11.6, 15.4, 17.7, 21.3, 25.4, 25.9 and 37.1, respectively. The cost-effectiveness for the most effective treatments was less than 5 million of pesetas per year of life gained in males presenting a cholesterol concentration higher than 300 mg/dl (7.76 mmol/l) and those under the age of 65 years. In women the cost-effectiveness was lower than 10 million of pesetas per year of life gained in those presenting more than 340 mg/dl (8.79 mmol/l) under the age of 65 years.

Conclusions: The results of this study demonstrate that the administration of lovastatine at 0.02 g/day is the most effective hypolipemiant treatment in preventing coronary heart disease.