The Cost of Reaching National Cholesterol Education Program (NCEP) Goals in Hypercholesterolaemic Patients
- First Online:
- 32 Downloads
Objective: Recognising the importance of treating hyperlipidaemia, the National Cholesterol Education Program (NCEP) has established widely accepted treatment goals for low density lipoprotein cholesterol (LDL-C). Medications used most commonly to achieve these LDL-C goals are HMG-CoA reductase inhibitors. The relative resource utilisation and cost associated with the use of reductase inhibitors of different LDL-C lowering efficacy are unknown, but are major health and economic concerns. The objective of this study was to determine the mean total cost of care to reach NCEP goals with various reductase inhibitors.
Design: In a randomised, 54-week, 30-centre controlled trial we compared resources used and costs associated with treating patients to achieve NCEP goals using 4 reductase inhibitors: atorvastatin, simvastatin, lovastatin and fluvastatin.
Patients and Participants: The trial studied 662 patients; 318 had known atherosclerotic disease.
Interventions: Reductase inhibitor therapy was initiated at recommended starting doses and increased according to NCEP guidelines and package insert information. For patients who did not reach the goal at the highest recommended dose of each reductase inhibitor, the resin colestipol was added.
Main outcome measures and results: Patients treated with atorvastatin, compared with other reductase inhibitors, were more likely to reach NCEP goals during treatment (p < 0.05), required fewer office visits (p < 0.001) and less adjuvant colestipol therapy (p = 0.001). Consequently, the mean total cost of care (1996 values) to reach NCEP goals was lower with atorvastatin [$US1064; 95% confidence interval (CI): $US953 to $US1176] compared with simvastatin ($US1471; 95% CI: $US1304 to $US1648), lovastatin ($US1972; 95% CI: $US1758 to $US2186) and fluvastatin ($US1542; 95% CI: $US1384 to $US1710). Results were similar for patients with or without known atherosclerotic disease.
Conclusions: In patients requiring drug therapy for hypercholesterolaemia, NCEP LDL-C goals are achieved significantly more often using fewer resources with atorvastatin compared with simvastatin, lovastatin or fluvastatin.
Unable to display preview. Download preview PDF.
- 1.Summary of the second report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). JAMA 1993; 269: 3015–23Google Scholar
- 2.Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9Google Scholar
- 5.Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia: report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 1990; 323: 946–55PubMedCrossRefGoogle Scholar
- 12.Zocor. Physicians desk reference. 49th ed. [atMontvale (NJ): Medical Economics Co., 1995: 1655–8Google Scholar
- 13.Mevacor. Physicians desk reference. 49th ed. Montvale (NJ): Medical Economics Co., 1995: 1584–8Google Scholar
- 14.Lescol. Physicians desk reference. 49th ed. Montvale (NJ): Medical Economics Co., 1995: 2165–8Google Scholar
- 15.Remmell PS, Gorder DD, Hall Y, et al. Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT), I: use of a dietary monitoring tool. JAMA 1980; 76: 351–6Google Scholar
- 16.Freidewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without the use of a centrifuge. Clin Chem 1972; 18: 449–502Google Scholar
- 17.Lipid and lipoprotein analysis. In: The Laboratory Methods Committee, editors. Manual of laboratory operations: LRC program report (NIH). Vol. 1. Bethesda (MD): US Department of Health, Education, and Welfare, 1974: 75–628Google Scholar
- 18.Practice Management Information Corporation (PMIC). [tiPhysician fees: a comprehensive guide for fee schedule review and management. Los Angeles: PMIC, 1996Google Scholar
- 19.Drug topics red book. Montvale (NJ): Medical Economic Company Inc., 1996Google Scholar
- 20.Agramowitz M, editor. Atorvastatin: a new lipid-lowering drug. Med Lett Drugs Ther 1997; 39: 29–31Google Scholar
- 21.Lawless JF. Statistical models and methods for lifetime data. New York: Wiley, 1982Google Scholar
- 23.American Heart Association. Heart and stroke facts [statistical supplement]. Dallas (TX): American Heart Association, 1996Google Scholar