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Primary prevention of cardiovascular disease: Cost-effectiveness comparison

Published online by Cambridge University Press:  18 January 2007

Oscar H. Franco ,
Arno J. der Kinderen ,
Chris De Laet ,
Anna Peeters  and
Luc Bonneux
Oscar H. Franco
Affiliation:
University Medical Center RotterdamandUnilever Corporate Research
Arno J. der Kinderen
Affiliation:
University Medical Center Rotterdamand St. Alatus
Chris De Laet
Affiliation:
Belgian Health Care Knowledge Center
Anna Peeters
Affiliation:
Monash University CentralandEastern Clinical School
Luc Bonneux
Affiliation:
Netherlands Interdisciplinary Demographic Institute
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Abstract

Objectives: The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease.

Methods: Using data from the Framingham Heart Study and the Framingham Offspring study, we built life tables to model the benefits of the selected interventions. Participants were classified by age and level of risk of coronary heart disease. The effects of risk reduction are obtained as numbers of death averted and life-years saved within a 10-year period. Estimates of risk reduction by the interventions were obtained from meta-analyses and costs from Dutch sources.

Results: The most cost-effective is smoking cessation therapy, representing savings in all situations. Aspirin is the second most cost-effective (€2,263 to €16,949 per year of life saved) followed by antihypertensives. Statins are the least cost-effective (€73,971 to €190,276 per year of life saved).

Conclusions: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.

Keywords

Primary preventionCardiovascular diseaseCost-effectiveness analysis
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 1 , January 2007 , pp. 71 - 79
Copyright
© 2007 Cambridge University Press

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References

Anderson KM, Odell PM, Wilson PW, Kannel WB. 1991 Cardiovascular disease risk profiles. Am Heart J. 121: 293– 298.Google Scholar
College, Tarieven Gezondheidszorg. Available at: www.ctgzorg.nl. Accessed 2004.
College voor zorgverzekeringen. 2003. Farmacotherapeutisch Kompas: medisch farmaceuthische voorlichting/uitgave van de Commissie Farmaceuthische hulp van het College voor zorgverzerkeringen. Amstelveen: College voor zorgverzekeringen
Committee SMA. Standing Medical Advisory Committee. the use of statins. 1997 (11061 HCD Aug 97 [04]). London: Department of Health.
Dawber TR, Meadors GF, Moore FE Jr. 1951 Epidemiological approaches to heart disease: The Framingham Study. Am J Public Health. 41: 279– 281.Google Scholar
Drummond M, Brandt A, Luce B, Rovira J. 1993 Standardizing methodologies for economic evaluation in health care. Practice, problems, and potential. Int J Technol Assess Health Care. 9: 26– 36.Google Scholar
Euro-medicines. Available at: www.euromedicines.org. Accessed 2001.
Franco OH, Peeters A, Looman CW, Bonneux L. 2005 Cost effectiveness of statins in coronary heart disease. J Epidemiol Community Health. 59: 927– 933.Google Scholar
Hayden M, Pignone M, Phillips C, Mulrow C. 2002 Aspirin for the primary prevention of cardiovascular events: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 136: 161– 172.Google Scholar
Hebert PR, Gaziano JM, Chan KS, Hennekens CH. 1997 Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA. 278: 313– 321.Google Scholar
Hofman A, Grobbee DE, de Jong PT, van den Ouweland FA. 1991 Determinants of disease and disability in the elderly: The Rotterdam Elderly Study. Eur J Epidemiol. 7: 403– 422.Google Scholar
Hughes JR, Stead LF, Lancaster T. 2003; Antidepressants for smoking cessation. Cochrane Database Syst Rev. CD000031.Google Scholar
Hunink MGM GP, Siegel JE, et al. 2001. Decision making in health and medicine: Interpreting evidence and values. Cambridge, England: Cambridge University Press;
Jacobson TA. 2001 Clinical context: Current concepts of coronary heart disease management. Am J Med. 110 (Suppl 6A): 3S– 11S.Google Scholar
Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP. 1979 An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol. 110: 281– 290.Google Scholar
Laine L. 2001 Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology. 120: 594– 606.Google Scholar
LaRosa JC, He J, Vupputuri S. 1999 Effect of statins on risk of coronary disease: A meta-analysis of randomized controlled trials. JAMA. 282: 2340– 2346.Google Scholar
Laupacis A, Feeny D, Detsky AS, Tugwell PX. 1992 How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 146: 473– 481.Google Scholar
Law MR, Wald NJ. 2002 Risk factor thresholds: Their existence under scrutiny. BMJ. 324: 1570– 1576.Google Scholar
Lightwood JM, Glantz SA. 1997 Short-term economic and health benefits of smoking cessation: Myocardial infarction and stroke. Circulation. 96: 1089– 1096.Google Scholar
Malik IS, Bhatia VK, Kooner JS. 2001 Cost effectiveness of ramipril treatment for cardiovascular risk reduction. Heart. 85: 539– 543.Google Scholar
Marshall T. 2003 Coronary heart disease prevention: Insights from modelling incremental cost effectiveness. BMJ. 327: 1264.Google Scholar
Neal B, MacMahon S, Chapman N. 2000 Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet. 356: 1955– 1964.Google Scholar
Parrott S, Godfrey C. 2004 Economics of smoking cessation. BMJ. 328: 947– 949.Google Scholar
Pharoah PD, Hollingworth W. 1996 Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: Life table method applied to health authority population. BMJ. 312: 1443– 1448.Google Scholar
Report HIC. Dutch guidelines for pharmacoeconomic research. Available at: www.ispor.org/PEguidelines/source/PE_guidelines_english_Netherlands.pdf. Accessed 1999.
Shepherd J, Cobbe SM, Ford I, et al. 1995 Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 333: 1301– 1307.Google Scholar
Silagy C, Lancaster T, Stead L, Mant D, Fowler G. 2002; Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. CD000146.Google Scholar
Statistikbank HeD. Available at: www.statistikbanken.dk. Accessed 2004.
van Hout BA. 1998 Discounting costs and effects: A reconsideration. Health Econ. 7: 581– 594.Google Scholar
van Hout BA, Simoons ML. 2001 Cost-effectiveness of HMG coenzyme reductase inhibitors; whom to treat? Eur Heart J. 22: 751– 761.Google Scholar
Wald NJ, Law MR. 2003 A strategy to reduce cardiovascular disease by more than 80%. BMJ. 326: 1419.Google Scholar
Weisman SM, Graham DY. 2002 Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med. 162: 2197– 2202.Google Scholar