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 .
Unwitnessed out-of-hospital cardiac arrest: is resuscitation worthwhile?
STUDY OBJECTIVE To determine the epidemiology of unwitnessed out-of-hospital cardiac arrest and the factors associated with survival after resuscitation using the Utstein style data collection . METHODS We conducted a prospect i ve cohort study in a 525,000- population city served by a single EMS system comprising a tiered response with physicians in the field . We studied consecutive unwitnessed out-of-hospital cardiac arrests that occurred between January 1 , 1994 , and December 31 , 1995 . We determined survival from cardiac arrest to discharge from hospital and the factors associated with survival . RESULTS Of the 809 patients for whom resuscitation was considered , 205 ( 25.3 % ) had sustained unwitnessed arrests . Cardiac origin of arrest was verified in 52 % of cases . The most common noncardiac causes of arrest were trauma , intoxication , near-drowning , and hanging . In 150 patients ( 73.2 % ) the presenting rhythm was asystole , in 28 ( 13.6 % ) it was pulseless electrical activity , and in 27 ( 13.2 % ) it was ventricular fibrillation . Resuscitation was attempted in 162 cases , 59 ( 36.4 % ) of whom demonstrated return of spontaneous circulation ; 45 ( 27.8 % ) were hospitalized alive , and 8 ( 4.9 % ) were discharged . The survivors represented 6.7 % of all out-of-hospital cardiac arrest survivors during the study period . Survival was most likely if patients presented with pulseless electrical activity ; none of the patients with asystole of cardiac origin survived . Sex ( P = .032 ) , age ( inverse relationship , P = .0004 ) , scene of collapse ( P = .042 ) , and interval from call receipt to arrival of first responders ( P = .004 ) were associated with survival . In a logistic-regression model , near-drowning remained an independent factor of survival ( odds ratio , 15.5 ; 95 % confidence interval , 1.2 to 200 ) . A routine priority dispatching protocol differentiated cardiac arrest patients with survival potential from those who already had irreversible signs of death . CONCLUSION This survey shows that survival after unwitnessed out-of-hospital cardiac arrest is unlikely with an initial response of basic life support alone . Withdrawal of resuscitation should be considered if an adult victim of unwitnessed cardiac arrest is found in asystole and the arrest is of obvious cardiac origin
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 .