PRIMARY PREVENTION OF CORONARY HEART-DISEASE IN THE FEDERAL-REPUBLIC-OF-GERMANY ANALYSIS OF COST-EFFECTIVENESS

The cost-effectiveness of a primary prevention strategy for coronary heart disease is reviewed in this paper. Five subgroups were identified, depending on the degree of medical intervention required to achieve a target low density lipoprotein (LDL)-cholesterol level of < 4.15 mmol/L. One group required no intervention and, apart from initial screening costs, no further treatment costs were incurred. The cost-effectiveness of medical intervention in the other groups was calculated by use of mathematical models to predict the incidence of coronary heart disease. According to this analysis, life-years saved per 1000 individuals and cost per life-years saved increased as the intensity of intervention increased. In individuals in whom a reduction in total cholesterol was required, life expectancy did not improve substantially, but the onset of coronary heart disease was deferred until an older age. Cholesterol-lowering interventions are unlikely to result in important savings to the health care system, as the benefit of treatment is rather reflected in terms of reduced mortality and improved quality of life. Total costs (in Deutschmarks [DM]) per life-year saved in this analysis were DM30 000-40 000 in men and DM86 000-110 000 in women. © 1990, Adis International Limited. All rights reserved.