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Pharmacoeconomics. 1998 May;13(5 Pt 2):623-43.

Cost-effectiveness analysis of treatments to reduce cholesterol levels, blood pressure and smoking for the prevention of coronary heart disease: evaluative study carried out in Spain.

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General Direction of Public Health, Department de Sanitat, Travessera Corts 131-159, 08028 Barcelona, Spain.


This study assessed the cost effectiveness of treatments for the primary prevention of coronary heart disease in Spain, which included smoking cessation and reductions in blood cholesterol levels and BP. Cost-effectiveness ratios (measured in terms of US dollars per life-year gained) ranged from 2,608 US dollars to 8,058 US dollars per life-year gained for therapies aimed at smoking cessation, from 7,061 US dollars to 126,990 US dollars per life-year gained for antihypertensive drug treatment, from 15,487 US dollars to 1,689,022 US dollars per life-year gained for the drug treatment of hypercholesterolaemia and from 12,792 US dollars to 149,246 US dollars per life-year gained for cholesterol-lowering diets. In individuals with blood cholesterol levels of 7.7 mmol/L, cost-effectiveness ratios of drug treatment ranged from 33,850 US dollars to 302,088 US dollars. Cost-effectiveness ratios were lower in men than in women for all programmes evaluated. Cost-effectiveness analysis of cholesterol-lowering drugs indicated that lovastatin (HMG-CoA reductase inhibitor) was more cost effective than cholestyramine (bile acid sequestrant) and gemfibrozil (fibrate). Hydrochlorothiazide, propranolol and nifedipine were more cost effective antihypertensive treatments than prazosin and captopril. Cost-effectiveness ratios obtained in this study could be used to develop disease management strategies to facilitate the efficient use of healthcare resources and to reduce costs. When resources for coronary heart disease are limited, available treatments should be selected on the basis of their average and incremental cost-effectiveness ratios.

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