The cost-effectiveness of lipid lowering in patients with ischaemic heart disease: an intervention and evaluation in primary care.

backgroundThere has been a major revolution in the recommended treatment of hyperlipidaemia in patients with ischaemic heart disease following the publication of the Scandinavian Simvastatin Survival Study. This was the first major study to demonstrate that lipid-lowering drugs reduced mortality and morbidity in patients with ischaemic heart disease.

aimTo evaluate the feasibility and cost-effectiveness of screening and treating hyperlipidaemia in patients with ischaemic heart disease in primary care.

methodA study conducted in a rural dispensing training practice on the border of Nottinghamshire and Lincolnshire involving 327 patients with ischaemic heart disease who were registered with the practice on 1 January 1996.

resultsEighty per cent of patients with ischaemic heart disease were considered eligible for screening and 80% of those attended for screening. The majority of patients who were screened had hyperlipidaemia that persisted after dietary advice. Despite lipid-lowering drugs, few patients had serum lipid concentrations in the target range at the end of six months. The costs of identifying and treating 83 patients with lipid-lowering drugs over five years is estimated at 105,318 Pounds at 1996 prices, or 94,257 Pounds assuming a 6% discount rate per annum. Two-thirds of this is owing to the cost of lipid-lowering drugs. The discounted cost per coronary event prevented would be 17,138 Pounds (95% CI = 12,568 Pounds-26,183 Pounds). The discounted cost per coronary death prevented would be 32,502 Pounds (95% CI = 23,564 Pounds-55,445 Pounds). There were no important adverse effects of lipid-lowering drugs on quality of life or mood.

conclusionSuch a programme is feasible and acceptable within primary care, although the ongoing cost implications need to be considered against the costs and benefits of other interventions.