The cost-effectiveness of the statins is even more dependent on the patient population in the primary prevention of CHD. Goldman et al51 reported variation in the cost-effectiveness of lovastatin therapy depending on age, sex, and risk factors. Therapy was not cost-effective in any subgroup of women, and only men with particular combinations of risk factors (eg, overweight smokers with high blood pressure) had costs less than $40000 per YOLS. By using a model that included the benefits of increasing the HDL-C level, Hamilton et al57 found that lovastatin therapy was generally cost-effective for low-risk men aged 40 to 60 years and for low-risk women in their 50s and 60s, with cost-effectiveness ratios of $28000 to $34,000 and $35000 to $44000, respectively (1992-1993 US dollars). For men in their 30s and 60s, as well as women younger than 50 years, lovastatin therapy was less cost-effective, with cost-effectiveness ratios ranging from $54000 to $120000. Among high-risk patients, the cost per YOLS for lovastatin therapy among men ranged from $13000 to $33000. Hay et al58 incorporated the indirect benefits of reduced disability days in a model with results that were slightly more favorable to statin therapy. They estimated that, in general, for patients with more than 3 risk factors (including male sex, high blood pressure, smoking habit, diabetes, or left ventricular hypertrophy), treatment with lovastatin cost less than $30000 per YOLS (1989 dollars).