A Mathematical Representation of the Expert Panel's Guidelines for Nigh Blood Cholesterol Case-finding and Treatment

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Abstract
The National Cholesterol Education Program (NCEP) for high blood cholesterol case-finding and treatment recommended discrete treatments according to the results of sequential mea surements of continuous variables (total and low-density lipoprotein cholesterol [LDL-C]). These measurements are subject to intra- and interindividual variability. The authors describe a computer simulation of the NCEP that acknowledges these complexities. The simulation reduces the NCEP into steps, which are represented in a decision tree. The calculation of probabilities at chance nodes takes into account the conditional nature of sequential mea surements of blood cholesterol. The simulation tracks medical resource use and estimates LDL-C reductions within 20 strata, each defining 5% of population distribution for LDL-C. This approach enables a detailed representation of the case-finding process—the sequence of blood cholesterol tests and associated cut-off values that identify individuals needing more intensive evaluation and treatment. Key words: mathematical modeling; screening programs; hypercholesterolemia. (Med Decis Making 1990;10:135-146)