The cost of treating dyslipidaemia using National Cholesterol Education Program (NCEP) guidelines

Coronary heart disease (CHD) is a major cause of death in industrialised countries and places a large burden on society in terms of healthcare resources and lost productivity. US National Cholesterol Education Program (NCEP) guidelines recommend aggressive lipid-modifying therapy for individuals at highest risk for CHD. It has been estimated that more than 50 million individuals in the US (more than one-third of the total population) are candidates for some form of dietary and/or pharmacological intervention to modify their lipid profiles. Most individuals who receive lipid-lowering drug therapy do not meet target goals set by the NCEP; thus, there is a large potential for increased use of drug therapy. Pharmacoeconomic analyses applying NCEP guidelines are sparse; however, available data (using direct costs) suggest that secondary prevention is more cost effective than primary prevention, but that costs associated with primary prevention are generally in line with those of accepted medical interventions. Cost-effectiveness ratios for secondary prevention improved when indirect costs were assessed in one study. A recent randomised prospective 54-week comparative study of statins in 662 patients with hypercholesterolaemia concurrently measured medical outcomes and economic data. Atorvastatin-treated patients were significantly more likely to achieve NCEP goals (overall and at the initial dosage), and to achieve these goals more quickly than patients treated with fluvastatin, lovastatin and simvastatin. The mean cost to reach NCEP goals was consequently lowest for atorvastatin. Results from pharmacoeconomic studies of primary and secondary prevention are therefore in support of NCEP treatment guidelines for hypercholesterolaemia.