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.