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 .
Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration
We carried out a systematic overview using individual patient data from the seven r and omised trials that have compared a strategy of initial coronary artery bypass graft ( CABG ) surgery with one of initial medical therapy to assess the effects on mortality in patients with stable coronary heart disease ( stable angina not severe enough to necessitate surgery on grounds of symptoms alone , or myocardial infa rct ion ) . 1324 patients were assigned CABG surgery and 1325 medical management between 1972 and 1984 . The proportion of patients in the medical treatment group who had undergone CABG surgery was 25 % at 5 years , 33 % at 7 years , and 41 % at 10 years : 93.7 % of patients assigned to the surgery group underwent CABG surgery . The CABG group had significantly lower mortality than the medical treatment group at 5 years ( 10.2 vs 15.8 % ; odds ratio 0.61 [ 95 % CI 0.48 - 0.77 ] , p = 0.0001 ) , 7 years ( 15.8 vs 21.7 % ; 0.68 [ 0.56 - 0.83 ] , p < 0.001 ) , and 10 years ( 26.4 vs 30.5 % ; 0.83 [ 0.70 - 0.98 ] ; p = 0.03 ) . The risk reduction was greater in patients with left main artery disease than in those with disease in three vessels or one or two vessels ( odds ratios at 5 years 0.32 , 0.58 , and 0.77 , respectively ) . Although relative risk reductions in subgroups defined by other baseline characteristics were similar , the absolute benefits of CABG surgery were most pronounced in patients in the highest risk categories . This effect was most evident when several prognostically important clinical and angiographic risk factors were integrated to stratify patients by risk levels and the extension of survival at 10 years was examined ( change in survival -1.1 [ SE 3.1 ] months in low-risk group , 5.0 [ 4.2 ] months in moderate-risk group , and 8.8 [ 5.4 ] months in high-risk group ; p for trend < 0.003 ) . A strategy of initial CABG surgery is associated with lower mortality than one of medical management with delayed surgery if necessary , especially in high-risk and medium-risk patients with stable coronary heart disease . In low-risk patients , the limited data show a non-significant trend towards greater mortality with CABG
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 .