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 .
Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival.
OBJECTIVES We sought to describe the incidence , characteristics and survival of out-of-hospital sudden cardiac arrest ( SCA ) in the Maastricht area of The Netherl and s. BACKGROUND Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services . Our population -based study in the Maastricht area allows information on all victims of witnessed and unwitnessed SCA occurring outside the hospital . METHODS Incidence , patient characteristics and survival rates were determined by prospect ively collecting information on all cases of SCA occurring in the age group 20 to 75 years between January 1 , 1991 and December 31 , 1994 .  Survival rates were related to the site of the event ( at home vs. outside the home ) and the presence or absence of a witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA . RESULTS Five hundred fifteen patients were included ( 72 % men , 28 % women ) . In 44 % of men and 53 % of women , SCA was most likely the first manifestation of heart disease . In patients known to have had a previous myocardial infa rct ion ( MI ) , the mean interval between the MI and SCA was 6.5 years , with > 50 % having a left ventricular ejection fraction > 30 % . The mean yearly incidence of SCA was 1 in 1,000 inhabitants . Of all deaths in the age groups studied , 18.5 % were sudden . Nearly 80 % of SCAs occurred at home . In 60 % of all cases of SCA a witness was present . Cardiac resuscitation , which was attempted in 51 % of all subjects , result ed overall in 32 ( 6 % ) of 515 patients being discharged alive from the hospital . Survival rates for witnessed SCA were 8 % ( 16 of 208 subjects ) at home and 18 % ( 15 of 85 subjects ) outside the home ( 95 % confidence interval 1 % to 18.8 % ) . CONCLUSIONS The majority of victims of SCA can not be identified before the event . Sudden cardiac arrest usually occurs at home , and the survival of those with a witnessed SCA at home was low compared with that outside the home , indicating the necessity of optimizing out-of-hospital resuscitation , especially in the at-home situation
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 .