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 .
A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease: two-year follow-up of the FRISC-II invasive study.
OBJECTIVES We sought to report the first and repeat events and to separate spontaneous and procedure-related events over two years in the Fast Revascularization during InStability in Coronary artery disease ( FRISC-II ) invasive trial . BACKGROUND The FRISC-II invasive trial compared the long-term effects of an early invasive versus noninvasive strategy , in terms of death and myocardial infa rct ion ( MI ) and the need for repeat hospital admissions and late revascularization procedures in patients with coronary artery disease ( UCAD ) . METHODS In the FRISC-II trial , 2,457 patients with UCAD were r and omized to an early invasive or noninvasive strategy .  RESULTS At 24 month follow-up , there were reductions in mortality ( n = 45 [ 3.7 % ] vs. 67 [ 5.4 % ] ; risk ratio 0.68 [ 95 % confidence interval ( CI ) 0.47 to 0.98 ] ; p = 0.038 ) , MI ( n = 111 [ 9.2 % ] vs. 156 [ 12.7 % ] ; risk ratio 0.72 [ 95 % CI 0.57 to 0.91 ] ; p = 0.005 ) , and the composite end point of death or MI ( n = 146 [ 12.1 % ] vs. 200 [ 16.3 % ] ; risk ratio 0.74 [ 95 % CI 0.61 to 0.90 ] ; p = 0.003 ) in the invasive compared with the noninvasive group . Procedure-related MIs were two to three times more common , but spontaneous ones were three times less common in the invasive than in the noninvasive group . After the first year , there was no difference in mortality ( n = 20 [ 1.7 % ] ) between the two groups and fewer MIs in the invasive group ( p = 0.031 ) . CONCLUSIONS In UCAD , the early invasive approach leads to a sustained reduction in mortality , cardiac morbidity , and the need for repeat hospital admissions and late revascularization procedures . Although the benefits are greatest during the first months , during the second year , cardiac morbidity is lower and the need for hospital care is less in the invasive group
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 .