TY - JOUR
T1 - The Cost-effectiveness of drug treatments for primary prevention of cardiovascular disease: a modelling study
AU - Marshall, Tom
PY - 2006/8/1
Y1 - 2006/8/1
N2 - BACKGROUND: Efficient prevention policies need to be informed by knowledge of the cost-effectiveness of preventive treatments. This paper calculates the cost-effectiveness of aspirin, antihypertensive treatments and statins for prevention of cardiovascular disease. DESIGN: The investigation is a modelling study. METHODS: Ten-year cardiovascular risks and treatment eligibility were determined for each individual in a population of 5603 obtained from the Health Survey of England. Using published costs and evidence of effectiveness the cost-effectiveness of treating each eligible individual was determined over a 10-year time horizon. The marginal cost-effectiveness of additional antihypertensive drugs and increasing doses of statins were determined and a sensitivity analysis was carried out. RESULTS: Of the 5603 individuals 27.5% (95% confidence interval, 26.3-28.7%) were eligible for at least one treatment: the majority of these were eligible for all three. Cost per cardiovascular disease event prevented is strongly determined by pretreatment cardiovascular disease risk. In three-quarters of patients eligible for all three treatments, the lowest cost per event prevented was with aspirin and in the remainder with two-drug antihypertensive treatment. The marginal costs per event prevented were highest with the addition of a fourth antihypertensive drug and statins. These findings depend on the use of low-cost antihypertensives but are otherwise robust to a wide range of assumptions. CONCLUSIONS: Modelling the cost-effectiveness of treatments to prevent cardiovascular disease is feasible and provides valuable information. Cost-effectiveness analysis argues for more widespread use of aspirin and two-drug antihypertensive treatment and against the use of four-drug antihypertensive treatment or statins.
AB - BACKGROUND: Efficient prevention policies need to be informed by knowledge of the cost-effectiveness of preventive treatments. This paper calculates the cost-effectiveness of aspirin, antihypertensive treatments and statins for prevention of cardiovascular disease. DESIGN: The investigation is a modelling study. METHODS: Ten-year cardiovascular risks and treatment eligibility were determined for each individual in a population of 5603 obtained from the Health Survey of England. Using published costs and evidence of effectiveness the cost-effectiveness of treating each eligible individual was determined over a 10-year time horizon. The marginal cost-effectiveness of additional antihypertensive drugs and increasing doses of statins were determined and a sensitivity analysis was carried out. RESULTS: Of the 5603 individuals 27.5% (95% confidence interval, 26.3-28.7%) were eligible for at least one treatment: the majority of these were eligible for all three. Cost per cardiovascular disease event prevented is strongly determined by pretreatment cardiovascular disease risk. In three-quarters of patients eligible for all three treatments, the lowest cost per event prevented was with aspirin and in the remainder with two-drug antihypertensive treatment. The marginal costs per event prevented were highest with the addition of a fourth antihypertensive drug and statins. These findings depend on the use of low-cost antihypertensives but are otherwise robust to a wide range of assumptions. CONCLUSIONS: Modelling the cost-effectiveness of treatments to prevent cardiovascular disease is feasible and provides valuable information. Cost-effectiveness analysis argues for more widespread use of aspirin and two-drug antihypertensive treatment and against the use of four-drug antihypertensive treatment or statins.
KW - cost-effectiveness
KW - aspirin
KW - cardiovascular disease
KW - statins
KW - antihypertensive treatment
UR - http://www.scopus.com/inward/record.url?scp=33746716911&partnerID=8YFLogxK
U2 - 10.1097/01.hjr.0000230098.63277.61
DO - 10.1097/01.hjr.0000230098.63277.61
M3 - Article
C2 - 16874140
SN - 1741-8267
VL - 13
SP - 523
EP - 528
JO - European Journal of Cardiovascular Prevention & Rehabilitation
JF - European Journal of Cardiovascular Prevention & Rehabilitation
IS - 4
ER -