The cost effectiveness of lipid lowering in Swedish primary health care. The CELL Study Group

Abstract

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.