Medical management and managing medical care: the dilemma of evaluating new technology

Economic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidence

STUDY OBJECTIVE

To investigate and evaluate published data on cost effectiveness of cholesterol lowering interventions, and how this information could be interpreted in a rational approach of cholesterol management in general practice.

DESIGN

A systematic review of the literature.

SETTING

No restriction on setting.

MATERIALS

Papers reporting on the cost effectiveness or cost utility of prevention of (recurrent) coronary heart disease by reduction of hypercholesterolaemia in adults.

MAIN RESULTS

Thirty nine studies, most cost effectiveness analyses, were included. In 24 studies drug interventions only were analysed. Costs of screening to target cholesterol lowering interventions to persons with hypercholesterolaemia were considered in nine studies. Adjustments of the efficacy of the intervention for community effectiveness were described in seven studies. In four studies life years gained were adjusted for quality of life. Despite large variation in the outcomes, there is a constant tendency towards a less favourable cost effectiveness ratio for intervening in persons without coronary heart disease compared with persons with coronary heart disease and for women compared with men.

CONCLUSIONS

There is lack of data on cost effectiveness of cholesterol lowering interventions in the general practice setting. The cost effectiveness of cholesterol lowering in general practice deteriorates when all relevant costs are taken into account and when efficacy is corrected for community effectiveness. Cholesterol lowering intervention is more cost effective in men compared with women and in patients with coronary heart disease compared with persons without coronary heart disease. Considerations from cost effectiveness analyses should be incorporated into the development and implementation of national cholesterol guidelines for general practitioners. Standardisation of cost effectiveness studies is important for future economic evaluations.

Information technology applications in quality assurance and quality improvement, Part II

Many information technologies have been or could be applied to efforts to measure and improve health care quality. This article reviews the recent literature in medical informatics, quality assurance, and quality improvement to identify these and current, emerging, and potential technologies.