The cost-effectiveness of different blood-cholesterol-lowering strategies in the prevention of coronary heart disease.

We aimed to compare the cost-effectiveness of two screening strategies and a population strategy for lowering blood cholesterol to prevent coronary heart disease. Census data, known risk-factor profiles, known coronary heart disease event rates and costs in 1988-89 Australian dollars for all men aged 35 to 64 in the Lower Hunter region of New South Wales (n = 67,651) were used to compare a high-risk strategy identifying and treating men with cholesterol levels above 6.5 mmol/L with diet and drug (cholestyramine), a moderate/high-risk strategy where in addition diet counselling was offered to those with levels 5.5 to 6.5 mmol/L, and a population strategy where the diet of the whole population was changed regardless of blood cholesterol. Costs of implementing strategies, heart disease events saved, discounted and undiscounted cost-effectiveness ratios and savings in initial treatment costs over five years were measured. For the high-risk, moderate/high-risk and population strategies, the costs of implementation were $50.1m, $53.1m and $5.4m respectively; the numbers of events saved were 104, 144, 116 respectively; cost-effectiveness ratios were $482,224, $369,098, $46,667 (per event saved) respectively. Cost savings for each strategy were approximately half a million dollars. The moderate/high-risk strategy was more cost-effective than the high-risk strategy but the population strategy cost one-tenth that of the two screening strategies per event saved. More research is required to design and test strategies that alter the eating habits of the whole population.