Goldman L, Gordon D J, Rifkind B M, Hulley S B, Detsky A S, Goodman D W, Kinosian B, Weinstein M C
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Circulation. 1992 May;85(5):1960-8. doi: 10.1161/01.cir.85.5.1960.
A broad, scientific consensus supports the role of cholesterol as a risk factor for coronary heart disease and agrees that lowering cholesterol levels will reduce coronary heart disease incidence. Cost-effectiveness analysis is a potentially powerful method for measuring the benefits to be achieved by expenditures of health care dollars.
The literature related to the effectiveness and cost-effectiveness of cholesterol lowering was reviewed. Application of cost-effectiveness methodology to the question of cholesterol reduction generally supports the use of population-wide educational programs and the aggressive use of cholesterol-lowering therapy for the secondary prevention of subsequent coronary events in persons with preexisting coronary heart disease. For primary prevention, however, therapy with medication has a favorable cost-effectiveness ratio only in identifiable high-risk persons, and the different costs of the various available medications should be taken into account. Therapy with medications, especially for primary prevention, would be more appealing if the price of the available medications were lower.
High priority should be given to research that could validate these cost-effectiveness projections as well as to further studies of the elderly and women, in whom direct data on the precise costs, risks, and benefits of interventions to lower cholesterol remain sparse.
广泛的科学共识支持胆固醇作为冠心病风险因素的作用，并认同降低胆固醇水平将降低冠心病发病率。成本效益分析是衡量医疗保健资金支出所能实现效益的一种潜在有力方法。
对与降低胆固醇的有效性和成本效益相关的文献进行了综述。将成本效益方法应用于胆固醇降低问题，总体上支持在全人群开展教育项目，并积极使用降胆固醇疗法对已有冠心病的患者进行后续冠心病事件的二级预防。然而，对于一级预防，药物治疗仅在可识别的高危人群中具有良好的成本效益比，并且应考虑各种可用药物的不同成本。如果现有药物价格更低，药物治疗，尤其是一级预防，将更具吸引力。
应高度重视能够验证这些成本效益预测的研究，以及对老年人和女性的进一步研究，目前关于降低胆固醇干预措施的确切成本、风险和益处的直接数据在这两类人群中仍然稀少。
