***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study set out to determine whether screening can be psychologically harmful to healthy adults . A prospect i ve controlled study was carried out on 215 healthy adults attending a by-invitation coronary heart disease screening clinic in general practice . The general health question naire was used as an indicator of recent psychological distress . Patients attending the screening clinic had significantly lower subjective psychological distress than an unscreened group of 225 age-matched controls , indicating that we may well be screening an already psychologically healthy sub-group . The main finding was that patients ' own assessment of their psychological distress was significantly increased three months after screening compared with that of controls , who showed a non-significant decrease . It is concluded that there is a real risk of causing distress by screening healthy adults and that this possibility has largely been ignored by previous studies . Possible explanations and implication s of these findings are discussed , particularly in the light of increased pressure from many quarters for more screening services to be set up in general practice A total of 96 patients with moderate elevations of low-density lipoprotein ( LDL ) cholesterol were r and omly assigned to 4 different double-blind treatment regimens : placebo ; colestipol 5 g and lovastatin 20 mg/day ( C5 + L20 ) ; colestipol 10 g and lovastatin 20 mg/day ( C10 + L20 ) ; and lovastatin 40 mg/day ( L40 ) . During 12 weeks of therapy , C10 + L20 achieved the greatest reduction in total cholesterol ( -32 % ) and LDL cholesterol ( -48 % ) levels from baseline . This combination also exhibited significantly greater reductions in LDL cholesterol levels than the C5 + L20 and L40 groups ( p < 0.01 ) . The differences in total and LDL cholesterol reduction between the C5 + L20 and L40 groups were not significant . Similar changes and differences between treatments were seen in apolipoprotein B levels . Whereas mean total apolipoprotein A-I levels increased with all treatments ( p < 0.05 ) , lipoprotein particles A-I were significantly increased in the C10 + L20 group ( p < 0.01 ) only . Results demonstrate that the combination of low-dose lovastatin ( 20 mg/day ) with low-dose colestipol ( 5 or 10 g/day ) produces LDL cholesterol reductions equal to or greater than higher doses of lovastatin ( 40 mg/day ) . In addition , low-dose combinations are > 25 % more cost-effective than high-dose monotherapy The cost of screening for hypercholesterolaemia in a clinical trial was investigated at a primary health care centre . A convenience sample of the population was screened for inclusion in a study of the effectiveness of a lipid lowering programme .  Included in the study were adults 30 - 59 years of age with a S-Cholesterol of 6.50 - 7.79 mmol l-1 at r and omization , plus two previous values > or = 6.50 mmol l-1 at screening and selection , with at least two other cardiovascular risk factors . In total 447 persons were screened and 37 were r and omized into the lipid lowering programme .  The mean cost per r and omized person was estimated at about SEK 7500 ( Swedish Crowns ) . An analysis of different inclusion criteria for treatment was also carried out . The cost of finding a patient to treat in the clinical trial was estimated to be more than three times as high with a total cholesterol cut-off point of 7.80 mmol l-1 compared with a cut-off point of 5.20 mmol l-1 This cost-benefit analysis attempts to translate the clinical findings of the Helsinki Heart Study ( HHS ) and published results regarding additional cardiovascular conditions into economic terms meaningful to US managed care providers . The study has the following 3 key objectives : to define the cost effectiveness of gemfibrozil in the prevention of coronary  heart disease ( CHD ) ; to assess the net impact of gemfibrozil on total treatment costs for CHD ; and to identify those patient groups for whom gemfibrozil therapy is most cost effective . In order to reach these findings a cost-effectiveness model was constructed based on original clinical data provided by the HHS , published findings for CHD risk and cost of treatment in the US , expert opinion and extension of HHS to other cardiovascular conditions , and documented costs and treatment protocol s of US Medicaid and privately managed health care programmes . The model was applied to the California Medicaid ( Medi-Cal ) programme to estimate costs of hyperlipidaemia therapy using gemfibrozil . In parallel , savings to Medi-Cal from averted coronary events were estimated . From these data , the net expected savings to Medi-Cal were calculated . The probability of experiencing CHD varies with cholesterol level , age , sex and risk factors such as smoking , hypertension and diabetes . Therefore , it is possible to use risk-factor profiles to define groups of individuals with low , moderate or high risk of experiencing acute myocardial infa rct ion ( AMI ) or sudden cardiac death . The probability of a cardiac event within 5 years ranges from 1.1 % in a 45-year-old low risk male to over 36 % in a 55-year-old high risk male . The average total cost of CHD care was found to be US$ 22,271 within 5 years . Using the probability of a CHD event to calculate the expected 5-year cost of CHD care produces a range from US$ 242 in the 45-year-old low risk male to US$ 8084 in the 55-year-old high risk male . Treatment with gemfibrozil reduces the probability of AMI and sudden cardiac death events by 34 % , as demonstrated in the HHS . Therefore , the corresponding probability ranges are reduced to 0.7 % in the 45-year-old low risk male and 27.3 % in the 55-year-old high risk male after treatment with gemfibrozil . The expected cost of a coronary event is reduced by US$ 82 and US$ 1997 , respectively . ( ABSTRACT TRUNCATED AT 400 WORDS Over the past decade the efficacy and cost of medical interventions have been subject to increasing scrutiny with quantitative techniques , such as the r and omized controlled trial and cost-effectiveness analysis . Such studies provide invaluable guidance for the clinician choosing from a limited range of options in caring for an individual patient . However , in the field of health policy myriad competing programs , services , institutions , and interests must be weighed . Unfortunately , quantitative methods are virtually always used to compare two , or at most a few , alternative strategies . Since the relative cost effectiveness of an intervention may appear radically different depending on the alternative . . Twenty-four factories or other occupational groups , employing 18 210 men aged 40 to 59 , were formed into matched pairs . One of each pair was allocated r and omly to receive a five to six year programme of medical examinations and intervention to reduce the levels of the main coronary risk factors . Men at factories in the intervention group were given advice on dietary reduction of plasma cholesterol concentrations , stopping or reducing cigarette smoking , regular exercies for the sedentary and reduced energy intake for the overweight , and hypertension was treated . The programme was delivered mainly through existing occupational medical services , helped by a small central staff . Personal consultations were largely confined to men with a high risk of developing coronary heart disease . Changes in risk factors were assessed by regular st and ardised examinations of r and om sample s of men . The spread of information by general propag and a proved easy , but a change in habits seemed to require personal contact . Small but significant reductions occurred , mainly in the high-risk group , but these were not sustained when pressure was relaxed STUDY OBJECTIVE : To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme . DESIGN : A prospect i ve cross sectional design . SETTING : A  community based intervention to reduce cardiovascular disease in the district of Norsjö ( n = 5500 ) , Sweden . The intervention was aim ed at both the general population and at individuals thought to be at special risk , the emphasis being on changing dietary habits and reducing cholesterol concentrations . PARTICIPANTS : The participants were men and women aged 30 - 60 years . MAIN RESULTS : The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20 % during the first six years of intervention . It was estimated that the programme 's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings , according to different assumptions . Taking only health care costs and savings into account , the cost per year of life saved ranged from 1100 pounds to 4050 pounds . The results varied between different sex and age groups , but not between social classes . Even if a causal relationship exists between low cholesterol concentrations and excess mortality , the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits . CONCLUSIONS : The community based intervention in Norsjö seems to be cost effective even under conservative assumptions . The approach used seems to have benefited all social classes . Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making BACKGROUND Advances in the treatment of cardiovascular disease have increased costs ; annual cardiovascular healthcare expenditure in the United States currently exceeds $ 100 billion . Physicians and third-party payers need to assess the economic impact of treatments that reduce cardiovascular morbidity and mortality . METHODS AND RESULTS The Sc and inavian Simvastatin Survival Study is a r and omized , double-blind , placebo-controlled trial in which simvastatin reduced the risk of death by 30 % ( P=.0003 ) over the median follow-up period of 5.4 years in patients with previous myocardial infa rct ion or stable angina pectoris as a result of a 42 % reduction in the risk of coronary deaths ( P=.00001 ) . In the present report , data prospect ively collected from hospital admissions were analyzed to evaluate the impact of simvastatin on healthcare re source use and perform a cost-minimization analysis . In the  placebo group ( n=2223 ) , there were 1905 hospitalizations ( average duration , 7.9 days ) for  acute cardiovascular events or coronary revascularization procedures  among 937 patients , whereas in the simvastatin group ( n=2221 ) , there were 1403 such hospitalizations ( average duration , 7.1 days ) among 720 patients ( all differences , P<.0001 ) . The corresponding number of hospital days was 15089 and 9951 in the two groups , respectively ( 34 % reduction , P<.0001 ) . In the United States , the result ing reduction in hospitalization costs over the 5.4 years of the trial would be $ 3872 per patient , reducing the effective cost of simvastatin by 88 % to $ 0.28 per day . CONCLUSIONS In addition to reducing mortality and morbidity in coronary heart disease patients , simvastatin markedly reduces use of hospital services , thus off setting most of its cost Abstract Objective : To measure the costs and cost effectiveness of the Oxcheck cardiovascular risk factor screening and intervention programme . Design : Cost effectiveness analysis of a r and omised controlled trial using clinical and economc data taken from the trial . Setting : Five general practice s in Luton and Dunstable , Engl and . Subjects : 2205 patients who attended a health check in 1989 - 90 and were scheduled for re-examination in 1992 - 3 ( intervention group ) ; 1916 patients who attended their initial health check in 1992 - 3 ( control group ) . Participants were men and women aged 35 - 64years . Intervention : Health check conducted by nurse , with health education and follow up according to degree of risk . Main outcome measures : Cost of health check programme ; cost per 1 % reduction in coronary risk . Results : Health check and follow up cost £ 29.27 per patient . Estimated programme cost per 1 % reduction in coronary risk per participant was between £ 1.46 and £ 2.25 ; it was nearly twice as much for men as women . Conclusions : The cost to the practice of implementing Oxcheck-style health checks in an average sized practice of 7500 patients would be £ 47 000 , a proportion of which could be paid for through staff pay reimbursements and B and Three health promotion target payments . This study highlights the considerable difficulties faced when calculating the costs and benefits of a health promotion programme . Economic evaluations should be integrated into the protocol s of r and omised controlled trials to enable judgments to be made on the relative cost effectiveness of different prevention strategies . Key messages Research was undertaken to estimate the cost of the health checks and relate the cost to changes in the relative risk of cardiovascular disease The immediate cost of implementing Oxcheck-style health checks in an average sized practice of 7500 patients would be £ 47 000 , which is comparable with the immediate cost of a cervical screening programme The actual costs to the practice would be substantially reduced by staff pay reimbursements and health promotion target payments Further research is required to estimate the wider costs of health checks result ing from the additional use of health care BACKGROUND The National Cholesterol Education Program recommends achievement of a defined target level of low-density lipoprotein cholesterol ( LDL-C ) for the treatment of hypercholesterolemia . They endorse the use of niacin and /or sequestrants as the first line of therapy to achieve such target LDL-C level . This recommendation has not been compared with the use of lovastatin as initial therapy if multidrug regimens are required to achieve goal LDL-C. METHODS Pro 
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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 .