Primary prevention and coronary heart disease: the economic benefits of lowering serum cholesterol.

We examined the expected economic benefits of cholesterol lowering for adult men with significant elevations of total serum cholesterol (above 260 mg/dl), incorporating estimates of direct benefits from anticipated reductions in lifetime expenditures for medical care, and estimates of indirect benefits related to extension of work-life secondary to reductions in morbidity and premature mortality. Our findings yield discounted lifetime direct benefits of a 15 per cent reduction in total serum cholesterol of $3 to $208 per person, and discounted lifetime indirect benefits of $1 to $8,946. Benefits increase with an individual's initial cholesterol level and decrease with the age at which an intervention is initiated. Economic benefits increase approximately twofold in the presence of other coronary risk factors, such as cigarette smoking and hypertension. Results suggest that cholesterol-lowering interventions, no matter what their cost, are unlikely to result in substantial direct savings to the health care system. However, the indirect benefits of intervention are quite high for young and middle-aged adults, as well as for those with severe elevations of cholesterol or with additional coronary risk factors.