COST-EFFECTIVENESS OF INCREMENTAL PROGRAMS FOR LOWERING SERUM-CHOLESTEROL CONCENTRATION - IS INDIVIDUAL INTERVENTION WORTH WHILE

Objective - To evaluate the relative cost effectiveness of various cholesterol lowering programmes. Design - Retrospective analysis. Setting - Norwegian cholesterol lowering programme in Norwegian male population aged 40-49 (n = 200 000), whose interventions comprise a population based promotion of healthier eating habits, dietary treatment (subjects with serum cholesterol concentration 6.0-7.9 mmol/l), and dietary and drug treatment combined (serum cholesterol concentration greater-than-or-equal-to 8.0 mmol/l). Main outcome measure - Marginal cost effectiveness ratios - that is, the ratio of net treatment costs (cost of treatment minus savings in treatment costs for coronary heart disease) to life years gained and to quality of life years (QALYs) saved. Results - The cost per life year gained over 20 years of a population based strategy was projected to be L12. For an individual strategy based on dietary treatment the cost was about L12 400 per life year gained and L111 600 if drugs were added for 50% of the subjects with serum cholesterol concentrations greater-than-or-equal-to 8.0 mmol/l. Conclusions - The results underline the importance of marginal cost effectiveness analyses for incremental programmes of health care. The calculations of QALYs, though speculative, indicate that individual intervention should be implemented cautiously and within more selected groups than currently recommended. Drugs should be reserved for subjects with genetic hypercholesterolaemia or who are otherwise at very high risk of arteriosclerotic disease.