At costs lower than $ 0.10 per pill , treating all persons with LDL cholesterol levels greater than 3.4 mmol/L ( > 130 mg/dL ) could be a better strategy .
Previous cost-effectiveness analyses ( 719 ) show that statin therapy is generally cost-effective for secondary prevention and for high-risk primary prevention but do not focus on population -level impact or average cost-effectiveness across the heterogeneous U.S. population , including such subgroups of patients as those with low risk but very high cholesterol levels .
Also , it is unclear whether the ATP III approach to risk stratification , in which risk is formally assessed only for patients with 2 or more established risk factors , is the simplest and most cost-effective way of targeting statin therapy .
The 2004 up date to ATP III ( 3 ) notes that treatment of high-risk subgroups may be useful even when cholesterol levels are low , which suggests that a more purely risk-based approach may be simpler and more cost-effective than the ATP III approach .
Context Which lipid-lowering policies with statins are cost-effective ?
Implication Optimum policies for lipid lowering with statins are highly dependent on statin costs .
The Editors Coronary heart disease ( CHD ) is the leading cause of death in the United States ( 1 ) .
Inhibitors of HMG-CoA reductase , known as statins , lower cholesterol and prevent CHD events and mortality ( 2 , 3 ) .
However , statins are expensive and sometimes cause side effects , which makes it difficult for patients , physicians , and policymakers to decide who should receive them .
The CHD Policy Model is a mathematical state-transition model of CHD in the United States that can be used to project event rates and costs related to CHD .
Diagnostic testing in acute myocardial infarction: does patient age influence utilization patterns? The Worcester Heart Attack Study.
To assess the impact of patient age on the use of diagnostic testing in the management of acute myocardial infa rct ion , the authors review ed the hospital charts of 4,109 patients hospitalized for vali date d acute myocardial infa rct ion in the Worcester , Massachusetts , metropolitan area during selected years between 1975 and 1986 . Older patients were more likely to be female and to have a prior history of angina , hypertension , and diabetes mellitus ( p less than 0.001 ) . Acute myocardial infa rct ions among older patients were more likely to be recurrent , anterior in location , non-Q wave , smaller as reflected by peak creatine kinase levels , and complicated by congestive heart failure , cardiogenic shock , and atrial fibrillation ( p less than 0.001 ) . In-hospital mortality was directly related to increasing patient age ( p less than 0.001 ) . Patterns of utilization of the following diagnostic tests were examined :  Holter monitoring , radionuclide ventriculography , echocardiography , exercise testing , pulmonary artery catheterization , and coronary arteriography .  After adjustment for differences in demographic and clinical characteristics and in-hospital mortality , patients aged 65 years and older were significantly less likely to undergo  exercise testing  than were patients less than age 55 . Patients older than age 75 were significantly less likely to undergo  radionuclide ventriculography , pulmonary artery catheterization , and coronary arteriography  than were younger patients . Sex-specific analyses did not produce results substantially different from those for the overall study population . The results of this community-wide study suggest that among patients hospitalized for acute myocardial infa rct ion , chronologic age may be an independent determinant of utilization patterns of diagnostic testing .  These findings suggest the need for a prospect i ve evaluation of this issue , with an additional emphasis placed on the contributions of functional status and noncardiovascular illness to decision-making in the clinical management of acute myocardial infa rct ion patients
At costs lower than $ 0.10 per pill , treating all persons with LDL cholesterol levels greater than 3.4 mmol/L ( > 130 mg/dL ) could be a better strategy .
Previous cost-effectiveness analyses ( 719 ) show that statin therapy is generally cost-effective for secondary prevention and for high-risk primary prevention but do not focus on population -level impact or average cost-effectiveness across the heterogeneous U.S. population , including such subgroups of patients as those with low risk but very high cholesterol levels .
Also , it is unclear whether the ATP III approach to risk stratification , in which risk is formally assessed only for patients with 2 or more established risk factors , is the simplest and most cost-effective way of targeting statin therapy .
The 2004 up date to ATP III ( 3 ) notes that treatment of high-risk subgroups may be useful even when cholesterol levels are low , which suggests that a more purely risk-based approach may be simpler and more cost-effective than the ATP III approach .
Context Which lipid-lowering policies with statins are cost-effective ?
Implication Optimum policies for lipid lowering with statins are highly dependent on statin costs .
The Editors Coronary heart disease ( CHD ) is the leading cause of death in the United States ( 1 ) .
Inhibitors of HMG-CoA reductase , known as statins , lower cholesterol and prevent CHD events and mortality ( 2 , 3 ) .
However , statins are expensive and sometimes cause side effects , which makes it difficult for patients , physicians , and policymakers to decide who should receive them .
The CHD Policy Model is a mathematical state-transition model of CHD in the United States that can be used to project event rates and costs related to CHD .