The costs and effects of two different lipid intervention programmes in primary health care.

Abstract

OBJECTIVE: To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia. DESIGN: Randomized, controlled trial. Subjects were randomly allocated to one of two intervention models and followed up for 1 year. SETTING: Vårby Health Centre, a primary care practice located in a suburb of Stockholm. SUBJECTS: Subjects with a total serum cholesterol in the range 7.0-7.8 mmol L-1 and no signs of ischaemic heart disease or diabetes mellitus, randomized to a low-intensity (n = 35) or medium-intensity (n = 41) intervention. INTERVENTION: Two strategies were used, one labelled medium-intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia, the other was a low-intensity strategy. MAIN OUTCOME MEASURES: Total serum cholesterol and intervention costs. RESULTS: Both intervention strategies resulted in small (mean 3.5%) decreases in total cholesterol with no significant difference between the groups. The cost per subject in the low-intensity group was SEK 753 and in the medium-intensity group SEK 3614. CONCLUSIONS: Because the effect of the two intervention programmes did not differ, the low-intensity programme is to be preferred from a cost-effectiveness point of view. If only one-third of the population in Stockholm county with cholesterol levels > or = 6.5 mmol L-1 are discovered by the primary health care system, and follow the treatment advice, the net savings in the low-intensity model compared to the current guidelines here presented as the moderate-intensity model, would be SEK 93 million.