A Clinical Practice Model to Estimate the Cost-Effectiveness of Lipid Lowering Therapy With Statins in Patients at Risk for Coronary Artery Disease

[摘要] Epidemiological, clinical, and laboratory studies have clearly established the relationship between elevated concentrations of serum lipids and increased risk for coronary artery disease. Conversely, it has also been demonstrated that lipid-lowering therapy with statins reduces the rate of cardiovascular events. Nevertheless, treatment with statins is costly.Thus, there has been an increased interest over the last few years in determining the cost-effectiveness of lipid-lowering therapy with statins. In this report we try to present a clinical practice model to estimate the cost-effectiveness of lipid lowering therapy with statins in patients at risk for coronary artery disease. Basically, the result of a cost-effectiveness analysis depends on the stage of the disease, the medication, its dose, as well as the resulting therapeutic effect. The greatest benefit of statin therapy can be expected for the highest absolute risk. It seems likely that a combined use of a risk-population strategy would ascertain the highest cost-effectiveness of lipid-lowering therapy with statins in daily medical practice. But, it would be unacceptable to conclude from improvement of surrogate parameters on clinical events and on cost-effectiveness. Treatment should proceed strictly from the results of the clinical endpoint trials.According to the results of the clinical endpoint studies, lipid-lowering therapy is essential in secondary prevention. To achieve maximum cost-effectiveness of treatment with statins, a comprehensive therapeutic approach, if necessary including revascularisation procedures is recommended.

[学科分类] 心脏病和心血管学

[关键词] Koronare Herzkrankheit;Kosteneffizienz;Lipidsenkung;Statin;coronary artery disease;cost effectiveness;lipid lowering therapy;Statin