Authors' objectives:

This review aimed to answer the following questions: 1. By how much do low fat and other diets reduce blood cholesterol, and how effective are they in reducing CHD risk? 2. Does treatment with statins reduce CHD events and are relative reductions in these events independent of the level of CHD risk? 3. How effective are non-cholesterol lowering drug treatments for reducing CHD risk relative to dietary and cholesterol lowering drug treatments? 4. What is the relative cost-effectiveness of different approaches to reducing cholesterol and/or CHD?

Authors' recommendations: The evidence on efficacy supports the use of statins over a wide range of CHD risks covering both primary and secondary prevention. Although statins are less cost-effective than other treatments, there is consensus that their use in secondary prevention is acceptable because they achieve effects additional to those of other treatments. However, there is evidence that these other treatments are insufficiently used in the UK and that greater efforts are required to ensure that highly cost-effective treatments are used optimally. The limited cost-effectiveness of statins in primary prevention indicates that their indiscriminate use might be a poor use of resources. Cost-effectiveness clearly improves with increasing baseline CHD risk. Scoring systems and guidelines have been developed to measure individual risk: most of these assume that 3% annual CHD risk marks the threshold between cost-effective and cost-ineffective use of statins. However, these scoring systems and guidelines have major weaknesses because they are derived from American data that are now out of date, and they do not consider variations between regional, ethnic or socio-economic groups. The price of statins is a major determinant of their relative cost-effectiveness: lower cost statins are available and their use would improve cost-effectiveness to the levels of low cost antihypertensive regimens. As the price of drugs is agreed by the Department of Health, there may be a case for further examining the prices of statins, given the very large potential market for these drugs in primary prevention. Targeting statin treatment at people aged 55 years and older would further improve cost-effectiveness. In public health terms, the major approaches to the primary prevention of CHD remain the fiscal and legislative control of tobacco, the reduction of hidden saturated fats and calories in the diet, encouraging and extending facilities available for physical activity throughout life, and the reduction of levels of poverty.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1052

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 1999 Queen's Printer and Controller of HMSO