N Engl J Med. 1997 Jan 30;336(5):332-6. Johannesson M， Jonsson B， Kjekshus J， Olsson AG， Pedersen TR， Wedel H.Center for Health Economics， Stockholm School of Economics， Sweden.

BACKGROUND: The Scandinavian Simvastatin Survival Study (4S) showed that lowering cholesterol levels with simvastatin reduces mortality and morbidity in patients with angina pectoris or previous acute myocardial infarction. Before the widespread use of cholesterol-lowering drugs in such patients is recommended， its cost effectiveness should be demonstrated. We estimated the cost effectiveness of simvastatin treatment to lower cholesterol levels in relation to the age， sex， and cholesterol level before treatment of patients with coronary heart disease.

METHODS: We estimated the cost per year of life gained with simvastatin therapy. To model the increased life expectancy， hazard functions from 4S were used. The costs studied included those of the intervention and the direct and indirect costs associated with morbidity from coronary causes. We prepared separate estimates for men and women at various ages (from 35 to 70 years) and total cholesterol levels before treatment (213 to 309 mg per deciliter).

RESULTS: In the analysis limited to direct costs， the cost of each year of life gained ranged from

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