Disease Management and Health Outcomes

, Volume 4, Issue 4, pp 193–203 | Cite as

Cholesterol-Lowering Therapy Interventions

A Pharmacoeconomic Assessment
  • Michael A. Kortt
  • Edward P. Armstrong
Review Articles Interventions & Outcomes


Elevated cholesterol levels are associated with an increased risk of cardiovascular diseases. Treatment strategies promoting the associated health benefits from a reduction in elevated cholesterol levels have been outlined in guidelines published by the National Cholesterol Education Program. Clinicians and researchers have also examined the economic benefits associated with reducing elevated cholesterol levels. Most of these studies have employed traditional pharmacoeconomic techniques like cost-effectiveness analysis. Results from these studies indicated that certain types of therapy interventions (such as the use of cholesterol-lowering pharmaceutical agents) are cost effective. However, the majority of these studies are clinically driven and rely heavily on cost-outcome ratios as decision variables.

This traditional approach to pharmacoeconomic evaluation is starting to be questioned by managed care organisations in the US. These organisations are increasingly interested in assessing the global (or health systems-based) impact associated with the introduction of a therapy intervention (such as cholesterol lowering agents). Subsequently, there is a need for pharmacoeconomic studies to provide a health systems-based view to assess a range of competing cholesterol-lowering treatment options.


Adis International Limited Simvastatin Lovastatin National Cholesterol Education Program Manage Care Organisation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    National Cholesterol Education Program second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). Bethesda (MD): National Institutes of Health, National Heart, Lung, and Blood Institute; 1993. NIH publication no. 93–3095Google Scholar
  2. 2.
    Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Summary of the second report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). JAMA 1993; 269: 3015–23CrossRefGoogle Scholar
  3. 3.
    Lipids Research Clinics Program. The lipids research clinics coronary primary prevention trial results: I. Reduction in the incidence of coronary heart disease. JAMA 1984; 251: 351–64CrossRefGoogle Scholar
  4. 4.
    Lipids Research Clinics Program. The lipids research clinics coronary primary prevention trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251: 365–74CrossRefGoogle Scholar
  5. 5.
    Frick MH, Elo O, Heinonen OP, et al. Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia, safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987; 317: 1237–45PubMedCrossRefGoogle Scholar
  6. 6.
    Manninen V, Tenkanen L, Koskinen P, et al. Joint effects of serum triglyceride and LDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study: implications for treatment. Circulation 1992; 85: 37–45PubMedCrossRefGoogle Scholar
  7. 7.
    Report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988; 148: 36–69Google Scholar
  8. 8.
    American College of Physicians. Guidelines for using serum cholesterol, high density lipoprotein, and triglyceride levels as screening tests for preventing coronary heart disease in adults. Ann Intern Med 1996; 124: 515–7Google Scholar
  9. 9.
    Langley PC. Therapy evaluation, patient distribution, and cost-outcome ratios. Clin Ther 1995; 17: 341–7PubMedCrossRefGoogle Scholar
  10. 10.
    Langley PC. Cost effectiveness profiles with an expanding treatment population. Clin Ther 1995; 17: 1207–12PubMedCrossRefGoogle Scholar
  11. 11.
    Langley PC. Cost effectiveness and the allocation of therapies in a treating population. Pharmacoeconomics 1996; 10: 93–8PubMedCrossRefGoogle Scholar
  12. 12.
    Langley PC, Coons SJ. Peripheral vascular disorders: a pharmacoeconomic and quality-of-life review. Pharmacoeconomics 1997; 11: 225–36PubMedCrossRefGoogle Scholar
  13. 13.
    Langley PC, Sullivan SD. Pharmacoeconomic evaluations: guidelines for drug purchasers. J Managed Care Pharm 1996; 2: 671–7Google Scholar
  14. 14.
    Phelps ES. Equilibrium: an expectational concept. In: Eatwell J, Milgate M, Newman P, editors. The New Palgrave: a dictionary of economics. Vol. 2. New York: Stockton Press, 1987: 177–9Google Scholar
  15. 15.
    Folland S, GoodmanZ AC, Stano M. The economics of health and health care. 2nd ed. New Jersey: Prentice Hall, 1997Google Scholar
  16. 16.
    Oster G, Epstein AM. Primary prevention and coronary heart disease: the economic benefits of lowering serum cholesterol. Am J Public Health 1986; 76: 647–56PubMedCrossRefGoogle Scholar
  17. 17.
    Weinstein MC, Stason WB. Cost-effectiveness of interventions to prevent or treat coronary heart disease. Ann Rev Public Health 1985; 6: 41–63CrossRefGoogle Scholar
  18. 18.
    Kinosian BP, Eisenberg JM. Cutting into cholesterol: cost effective alternatives for treating hypercholesterolemia. JAMA 1988; 259: 2249–54PubMedCrossRefGoogle Scholar
  19. 19.
    Martens LL, Rutten FFH, Erkelens DW, et al. Cost effectiveness of cholesterol-lowering therapy in The Netherlands. Am J Med 1989; 87 Suppl. 4A: 54–8SCrossRefGoogle Scholar
  20. 20.
    Martens LL, Rutten FFH, Erkelens DW, et al. Clinical benefits and cost-effectiveness of lowering serum cholesterol levels: the case of simvastatin and cholestyramine in The Netherlands. Am J Cardiol 1990; 65: 27–32FCrossRefGoogle Scholar
  21. 21.
    Schulman KA, Kinosian B, Jacobson TA, et al. Reducing high blood cholesterol level with drugs: cost-effectiveness of pharmacological management. JAMA 1990; 264: 3025–33PubMedCrossRefGoogle Scholar
  22. 22.
    Hay JW, Wittels EH, Gotto AM. An economic evaluation of lovastatin for cholesterol lowering and coronary artery disease reduction. Am J Cardiol 1991; 67: 789–96PubMedCrossRefGoogle Scholar
  23. 23.
    Hilleman DE, Pincus KT, Wadibia EC, et al. Comparative cost-effectiveness of bile acid sequestering resins, HMG Co-A reductase inhibitors, and their combination in patients with hypercholesterolemia. J Managed Care Pharm 1995; 1: 188–92Google Scholar
  24. 24.
    Ashraf T, Hay JW, Pitt B, et al. Cost-effectiveness of pravastatin in secondary prevention of coronary artery disease. Am J Cardiol 1996; 78: 409–14PubMedCrossRefGoogle Scholar
  25. 25.
    Jönsson B, Johannesson M, Kjekshus J, et al. Cost-effectiveness of cholesterol lowering: results from the Scandinavian simvastatin survival study (4S). Eur Heart J 1996; 17: 1001–7PubMedCrossRefGoogle Scholar
  26. 26.
    Johannesson M, Jönsson B, Kjekshus J, et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336: 332–6PubMedCrossRefGoogle Scholar
  27. 27.
    Johannesson M, Borgquist L, Jönsson B, et al. The cost effectiveness of lipid lowering in Swedish primary health care. J Intern Med 1996; 240: 23–9PubMedCrossRefGoogle Scholar
  28. 28.
    Pharoah PDP, Hollingworth W. Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to health authority population. BMJ 1996; 312: 1443–8PubMedCrossRefGoogle Scholar
  29. 29.
    Goldman L, Goldman PA, Williams LW, et al. Cost-effectiveness considerations in the treatment of heterozygous familial hypercholesterolemia with medications. Am J Cardiol 1993; 72: 75–9DCrossRefGoogle Scholar
  30. 30.
    Goldman L, Weinstein MC, Goldman PA, et al. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA 1991; 265: 1145–51PubMedCrossRefGoogle Scholar
  31. 31.
    Hamilton VH, Racicot FE, Zowall H, et al. The cost-effectiveness of HMG-CoA reductase inhibitors to prevent coronary heart disease. Estimating the benefits of increasing HDL-C. JAMA 1995, 237: 1032–8CrossRefGoogle Scholar
  32. 32.
    Kinlay S, O’Connell D, Evans D, et al. A new method of estimating cost effectiveness of cholesterol reduction therapy for prevention of heart disease. Pharmacoeconomics 1994; 5: 238–48PubMedCrossRefGoogle Scholar
  33. 33.
    Glick H, Heyse JF, Thompson D, et al. A model for evaluating the cost-effectiveness of cholesterol-lowering treatment. Int J Technol Assess Health Care 1992; 8: 719–34PubMedCrossRefGoogle Scholar
  34. 34.
    Chrisp P, Lewis NJW, Milne RJ. Simvastatin: a pharmacoeconomic evaluation of its cost-effectiveness in hypercholesterolaemia and prevention in coronary heart disease. Pharmacoeconomics 1992; 2: 124–45CrossRefGoogle Scholar
  35. 35.
    Ito MK. Should hyperlipdemia in the elderly be treated? Am J Health Syst Pharm 1996; 53: 2867–72PubMedGoogle Scholar
  36. 36.
    Davidson DM, Bradley BJ, Landry SM, et al. School-based cholesterol screening. J Pediatr Health Care 1989; 3: 3–8PubMedCrossRefGoogle Scholar
  37. 37.
    Armstrong EP, Manuchehri F. Ambulatory care databases for managed care organizations. Am J Health Sys Pharm 1997; 54: 1973–83Google Scholar
  38. 38.
    Else BA, Armstrong EP, Cox ER. Data sources for pharmacoeconomic and health service research. Am J Health Sys Pharm 1997; 54: 2601–8Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Michael A. Kortt
    • 1
  • Edward P. Armstrong
    • 2
  1. 1.Faculty of Economics, Business and Law, Department of EconomicsThe University of New EnglandArmidaleAustralia
  2. 2.Department of Pharmacy Practice and Science, and Health Outcomes and PharmacoEconomic Research Center, College of PharmacyThe University of ArizonaTucsonUSA

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