Cost-Effectiveness of Risk Factors

  • Harlan M. Krumholz
  • Lee Goldman


The identification of risk factors for cardiovascular disease prompts questions about the organization and implementation of risk factor modification programs. Are resources better spent on treating cardiovascular disease or preventing it? Should programs be adopted that screen all persons for risk factors or should the efforts be targeted to certain patient groups? Should all risk factors receive equal attention or are resources better directed toward certain risk factors? How can these different strategies be compared? These questions are difficult to answer and, in many cases, cannot be resolved easily. One method of addressing these questions is to compare the costs and benefits of alternative uses of health care resources.


Coronary Heart Disease Smoking Cessation Ideal Body Weight Cholesterol Reduction Risk Factor Modification 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Smith S, Freeland M, Heffler S, McKusick D: The next ten years of health spending: what does the future hold? Health Affairs 1998, 17: 128–140.PubMedCrossRefGoogle Scholar
  2. 2.
    Iglehart J: The end stage renal disease program. N Engl J Med 1993, 19. 328: 366–4371.CrossRefGoogle Scholar
  3. 3.
    National Cholesterol Education Program: Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Washington, DC: US Department of Health and Human Services; 1993. [NIH publication no. 93–3095.]Google Scholar
  4. 4.
    Wilson PWF, Christiansen JC, Anderson KM, et al.: Impact of national guidelines for cholesterol risk screening: the Framingham Offspring Study. JAMA 1989, 262: 41–44.PubMedCrossRefGoogle Scholar
  5. 5.
    Rembold CM: Number needed to screen: development of a statistic for disease screening. Br Med J 1998, 317: 302–312.CrossRefGoogle Scholar
  6. 6.
    Nieto FG, Alonso J, Chambless LE, et al.: Population awareness and control of hypertension and hypercholesterolemia: the atherosclerosis risk in communities study. Arch Intern Med 1995, 155: 677–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Tosteson ANA, Weinstein MC, Hunink MGM, et al.: Cost-effectiveness of population-wide educational approaches to reduce serum cholesterol levels. Circulation 1997, 95: 24–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Farquhar JW, Fortmann SP, Flora JA, et al.: Effects of a community-wide education on cardiovascular disease risk factors. JAMA 1990, 264: 359–365.PubMedCrossRefGoogle Scholar
  9. 9.
    Scandinavian Simvastatin Survival Study Group: Randomised trial of cholesterol lowering in 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994, 394: 1383–1389.Google Scholar
  10. 10.
    Sheperd J, Cabbe SM, Ford I, et al.: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995, 333: 1301–1307.CrossRefGoogle Scholar
  11. 11.
    Gould AL, Rossouw JE, Santanello NC, et al.: Cholesterol reduction yields clinical benefit. Circulation 1998, 97: 946–952.PubMedCrossRefGoogle Scholar
  12. 12.
    Caro J, Klittich A, McGuire A, et al.: The West of Scotland coronary prevention study: economic benefit analysis of primary prevention 30. with pravastatin. Br Med J 1997, 315: 1577–1582.CrossRefGoogle Scholar
  13. 13.
    Pedersen TR, Kjekshus J, Berg K, et al.: Cholesterol lowering and the use of healthcare resources. Circulation 1996, 93: 1796–1802.PubMedCrossRefGoogle Scholar
  14. 14.
    Johannesson M, Jonsson 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: 332–336.PubMedCrossRefGoogle Scholar
  15. 15.
    The Long-term Intervention with provastatin in Ischemic Disease (LIPID) study groups: Prevention of cardiovascular events and death with prevastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998, 339: 1349–1357.CrossRefGoogle Scholar
  16. 16.
    Sacks FM, Pfeffer MA, Moye LA, et al.: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996, 335: 1001–1009.PubMedCrossRefGoogle Scholar
  17. 17.
    Downs JR, Clearfield M, Weis S, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of the AFCAPS/TexCAPS. JAMA 1998, 279:1615–1622.Google Scholar
  18. 18.
    Goldman L, Weinstein M, Goldman P, et al.: Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA 1991, 265: 1145–1151.PubMedCrossRefGoogle Scholar
  19. 19.
    Weinstein M, Coxson P, Williams L, et al.: Forecasting coronary heart disease incidence, mortality, and cost: the coronary heart disease policy model. Am J Public Health 1987, 77: 1417–1426.PubMedCrossRefGoogle Scholar
  20. 20.
    Nieto FG, Alonso J, Chambless LE, et al.: Population awareness and control of hypertension and hypercholesterolemia: the atherosclerosis risk in communities study. Arch Intern Med 1995, 155: 677–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Littenberg B, Garber A, Sox HJ: Diagnosis and treatment: screening for hypertension. Ann Intern Med 1990, 112: 192–202.PubMedCrossRefGoogle Scholar
  22. 22.
    Edelson J, Weinstein M, Tosteson A, et al.: Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. JAMA 1990, 263: 407–413.PubMedCrossRefGoogle Scholar
  23. 23.
    Barendregt JJ, Bonneux L, van der Maas PJ: The health care costs of smoking. N Engl J Med 1997, 337: 1052–1057.PubMedCrossRefGoogle Scholar
  24. 24.
    Bartlett JC, Miller LS, Rice DP, Max WB: Medical-care expenditures attributable to cigarette smoking: United States, 1993. MMWR 1994, 43: 469–472.Google Scholar
  25. 25.
    Lightwood JM, Glantz SA: Short-term economic and health benefits of smoking cessation. J Am Coll Cardio11997, 96:1089–1096.Google Scholar
  26. 26.
    Oster G, Huse D, Delea T, et al.: Cost-effectiveness of nicotine gum as an adjunct to physician’s advice against cigarette smoking. JAMA 1986, 256: 1315–1318.PubMedCrossRefGoogle Scholar
  27. 27.
    Doll R, Peto R: Mortality in relation to smoking: twenty years observation on male British doctors. BMJ 1976, 2: 1525–1536.PubMedCrossRefGoogle Scholar
  28. 28.
    Sparrow D, Dawber T, Colton T: The influence of cigarette smoking on prognosis after a first myocardial infarction: a report from the Framingham Study. J Chronic Dis 1978, 31: 425–432.PubMedCrossRefGoogle Scholar
  29. 29.
    Aberg A, Bergstrand R, Johansson S: Cessation of smoking after myocardial infarction: effects on mortality after 10 years. Br Heart I 1983, 49: 416–422.CrossRefGoogle Scholar
  30. 30.
    Daly L, Mulcahy R, Graham I, et al.: Long-term effect on mortality of stopping smoking after unstable angina and myocardial infarction. BMJ 1983, 387: 324–326.CrossRefGoogle Scholar
  31. 31.
    Johansson S, Bergstrand R, Pennert K: Cessation of smoking after myocardial infarction in women: effects on mortality and reinfarctions. Am J Epidemiol 1985, 121: 823–831.PubMedGoogle Scholar
  32. 32.
    Perkins J, Dick T: Smoking and myocardial infarction: secondary prevention. Postgrad Med J 1985, 61: 295–300.PubMedCrossRefGoogle Scholar
  33. 33.
    Hedback B, Perk J: Five-year results of a comprehensive rehabilitation programme after myocardial infarction. Eur Heart J 1987, 8: 234–242.PubMedGoogle Scholar
  34. 34.
    Taylor A, Houston-Miller N, Killen J, et al.: Smoking cessation after acute myocardial infarction: effect of a nurse-managed intervention. Ann Intern Med 1990, 113: 118–123.PubMedCrossRefGoogle Scholar
  35. 35.
    Krumholz H, Cohen B, Tsevat J, et al.: Cost-effectiveness of a smoking cessation program after myocardial infarction. J Am Coll Cardiol 1993, 22: 1697–1702.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Harlan M. Krumholz
  • Lee Goldman

There are no affiliations available

Personalised recommendations