(Circulation. 1997;95:24-30.)
© 1997 American Heart Association, Inc.
Articles |
Cost-Effectiveness of Populationwide Educational Approaches to Reduce Serum Cholesterol Levels
the Clinical Research Section (A.N.A.T.), Department of Medicine and the Center for Evaluative Clinical Science, Dartmouth Medical School, Hanover, NH; Department of Health Policy and Management (M.C.W., M.G.M.H., L.W.W., P.A.G.), Harvard School of Public Health, Boston, Mass; Department of Health Sciences (M.G.M.H.), University of Groningen, Groningen, The Netherlands; Department of Medicine, Deaconess Hospital (M.A.M.), Boston, Mass; and Department of Medicine (L.G.), University of California, San Francisco School of Medicine.
Correspondence to Lee Goldman, MD, Professor and Chairman, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0120. E-mail lgoldman@ucsfvm.ucsf.edu.
Background The aim of the present study was to estimate the cost-effectiveness of populationwide approaches to reduce serum cholesterol levels in the US adult population.
Methods and Results This cost-effectiveness analysis was made from data from the literature and the Coronary Heart Disease Policy Model and was based on the US population age 35 to 84 years. Study interventions were populationwide programs to reduce serum cholesterol levels with costs and cholesterol-lowering effects similar to those reported from the Stanford Three-Community Study, the Stanford Five-City Project, and in North Karelia, Finland. The main outcome measures were cost-effectiveness ratios, defined as the change in projected cost divided by the change in projected life-years when the population receives the intervention compared with the population without the intervention. A populationwide program with the costs ($4.95 per person per year) and cholesterol-lowering effects (an average 2% reduction in serum cholesterol levels) of the Stanford Five-City Project would prolong life at an estimated cost of only $3200 per year of life saved. Under a wide variety of assumptions, a populationwide program would achieve health benefits at a cost equivalent to that of many currently accepted medical interventions. Such programs would also lengthen life and save resources under many scenarios, especially if the program affected persons with preexisting heart disease or altered other coronary risk factors.
Conclusions Populationwide programs should be part of any national health strategy to reduce coronary heart disease.
Key Words: cholesterol • coronary disease • cost-benefit analysis • prevention
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