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16 May 2000 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. Full content of the issue will be available on the Internet at on May 16, 2000.

"Statins" Lower Cholesterol But Are They Cost-Effective for Everyone?

Two studies in the May 16 Annals explore the cost-effectiveness of statins (cholesterol-lowering drugs) on specific populations that have not been well studied in randomized trials. One study found that statin therapy was reasonably cost-effective for patients 75 to 84 years old with a history of heart attack (Article, p. 780). It increased life expectancy in these patients on average about four months and cost about $18,800 per quality-adjusted life year, which, the authors say, is within range of other commonly accepted medical interventions.

Another study estimated the cost-effectiveness ratios of diet therapy, statin therapy and no preventive treatment in relation to a wide range of individual patient characteristics (Article, p. 769). The study found that cost-effectiveness varied significantly by age, sex, and heart disease risk factors, such as smoking, high- and low-density cholesterol levels and blood pressure.

An editorial says that the studies support targeting cholesterol-lowering drugs to patients who have an elevated risk for heart disease, with prevention after an initial heart event a high priority (Editorial, p. 833).

Patients, Families and Providers Describe a Good Death

In focus groups and in-depth interviews, 75 patients, families and providers identified six components of a good death, including clear decision making, preparation for death, and affirmation of the whole person (Perspective, p. 825). Physicians' opinions differed greatly from those of others. Physicians concentrated more on biomedical aspects of dying, while patients, families and others felt that psychosocial and spiritual issues were as important.

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