OBJECTIVE--To evaluate the relative cost effectiveness of various cholesterol lowering programmes. DESIGN--Retrospective analysis. SETTING--Norwegian cholesterol lowering programme in Norwegian male population aged 40-49 (n = 200,000), whose interventions comprise a population based promotion of healthier eating habits, dietary treatment (subjects with serum cholesterol concentration 6.0-7.9 mmol/l), and dietary and drug treatment combined (serum cholesterol concentration greater than or equal to 8.0 mmol/l). MAIN OUTCOME MEASURE--Marginal cost effectiveness ratios--that is, the ratio of net treatment costs (cost of treatment minus savings in treatment costs for coronary heart disease) to life years gained and to quality of life years (QALYs) saved. RESULTS--The cost per life year gained over 20 years of a population based strategy was projected to be 12 pounds. For an individual strategy based on dietary treatment the cost was about 12,400 pounds per life year gained and 111,600 pounds if drugs were added for 50% of the subjects with serum cholesterol concentrations greater than or equal to 8.0 mmol/l. CONCLUSIONS--The results underline the importance of marginal cost effectiveness analyses for incremental programmes of health care. The calculations of QALYs, though speculative, indicate that individual intervention should be implemented cautiously and within more selected groups than currently recommended. Drugs should be reserved for subjects with genetic hypercholesterolaemia or who are otherwise at very high risk of arteriosclerotic disease.

This article describes and discusses the effects of an information campaign carried out in 1987 when the strength of the insulin solution was changed from u-40 to u-100. The data comprised drug sales statistics, records of errors, questionnaires to pharmacies and hospitals and press cuttings. The campaign was organized by a group of experts appointed by the Directorate of Health. Local activities were carried out by pharmacies and hospitals, which proved to be effective information channels. Almost all diabetics changed to u-100 over a three-month period. We recorded incidents of serious erroneous prescribing and administration of insulin, but no deaths or irreversible injuries. It was more difficult to reach target groups of health personnel in the primary health care. The change led to a distinct and probably permanent rise in the sale of insulin in Norway.