National guidance that does not link costs and benefits is worthless

Last month the NHS Executive distributed to health authorities and general practitioners a statement from the Standing Medical Advisory Committee on the use of lipid lowering drugs.1 This argues for a strategy of treatment on the basis of underlying risk, but it adopts a level that is probably unachievable, fails to present the evidence, and ignores cost effectiveness. In so doing it jeopardises the objective of targeting high risk patients, but it also raises questions about the worth of guidance that does not link benefits and costs.

The statement recommends that, having considered other methods of reducing the risk of coronary heart disease, clinicians should give statins to the following three groups of patients. The first priority are patients who have had a myocardial infarction and have low density lipoprotein values of 3.2 mmol/l or more; second are those with angina or other clinically overt atherosclerotic disease with low density lipoprotein values of 3.7 mmol/l or more; and third come those with a high risk of developing coronary heart disease according to the revised Sheffield tables2 and a low density lipoprotein value of 3.7 mmol/l or more. The statement estimates that meeting all three priorities will mean treating 8.2% of the population aged 35-69. No recommendations are made for patients aged over 70, although there is no evidence that benefits are limited to younger patients. The statement was sent …