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Terry A. Jacobson, MD; Jeffrey R. Schein, DrPH; Amy Williamson, MPP; Christie M. Ballantyne, MD

Arch Intern Med. 1998;158:1977-1989.

Cardiovascular disease, including coronary heart disease, is the leading cause of death both in men and in women in the United States. The purpose of this review is to describe the effectiveness of lipid-lowering therapy in reducing cardiovascular morbidity and mortality, which has recently been extended to patients with mild to moderate hypercholesterolemia, and the cost of providing therapy, which would be prohibitive if all persons with hypercholesterolemia received treatment. Cost-effectiveness analysis provides a rational means of allocating limited health care resources by allowing the comparison of the costs of lipid-lowering therapy, in particular, therapy with -hydroxy--methylglutaryl-CoA (coenzyme A) reductase inhibitors (statins), with the costs of atherosclerosis that could be prevented by lowering cholesterol. To extend the benefits of treatment to the large number of persons not receiving therapy, we need to implement more cost-effective treatment by improving risk assessment, increasing treatment effectiveness, and reducing the cost of therapy.

From the Department of Medicine, Emory University, Atlanta, Ga (Dr Jacobson); Novartis Pharmaceuticals Corporation, East Hanover, NJ (Dr Schein); Lewin-TAG Inc, Boston, Mass (Ms Williamson); and Department of Medicine, Baylor College of Medicine, Houston, Tex (Dr Ballantyne). Dr Jacobson has received speaking and consulting honoraria from Bristol-Myers Squibb Company, Princeton, NJ; Novartis Pharmaceuticals Corporation; Merck & Co Inc, West Point, Pa; and Pfizer Inc, New York, NY. Ms Williamson is a consultant to Novartis Pharmaceuticals Corporation. Dr Ballantyne has received research support within the last 3 years from Novartis Pharmaceuticals Corporation; Merck & Co Inc; Parke-Davis, Morris Plains, NJ; and Pfizer Inc; is a consultant for Novartis and Merck; and is on the speakers' bureau and receives honoraria from Merck, Novartis, Parke-Davis, Pfizer, and Bristol-Myers Squibb.

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