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Primary prevention of cardiovascular disease: Cost-effectiveness comparison

  • Oscar H. Franco (a1), Arno J. der Kinderen (a2), Chris De Laet (a3), Anna Peeters (a4) and Luc Bonneux (a5)...

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.

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AndersonKM, OdellPM, WilsonPW, KannelWB. 1991Cardiovascular disease risk profiles. Am Heart J.121: 293298.

DawberTR, MeadorsGF, MooreFEJr. 1951Epidemiological approaches to heart disease: The Framingham Study. Am J Public Health.41: 279281.

DrummondM, BrandtA, LuceB, RoviraJ. 1993Standardizing methodologies for economic evaluation in health care. Practice, problems, and potential. Int J Technol Assess Health Care.9: 2636.

FrancoOH, PeetersA, LoomanCW, BonneuxL. 2005Cost effectiveness of statins in coronary heart disease. J Epidemiol Community Health.59: 927933.

HaydenM, PignoneM, PhillipsC, MulrowC. 2002Aspirin for the primary prevention of cardiovascular events: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med.136: 161172.

HebertPR, GazianoJM, ChanKS, HennekensCH. 1997Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA.278: 313321.

HofmanA, GrobbeeDE, de JongPT, van den OuwelandFA. 1991Determinants of disease and disability in the elderly: The Rotterdam Elderly Study. Eur J Epidemiol.7: 403422.

JacobsonTA. 2001Clinical context: Current concepts of coronary heart disease management. Am J Med.110(Suppl 6A): 3S11S.

KannelWB, FeinleibM, McNamaraPM, GarrisonRJ, CastelliWP. 1979An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol.110: 281290.

LaineL. 2001Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology.120: 594606.

LaRosaJC, HeJ, VupputuriS. 1999Effect of statins on risk of coronary disease: A meta-analysis of randomized controlled trials. JAMA.282: 23402346.

LawMR, WaldNJ. 2002Risk factor thresholds: Their existence under scrutiny. BMJ.324: 15701576.

LightwoodJM, GlantzSA. 1997Short-term economic and health benefits of smoking cessation: Myocardial infarction and stroke. Circulation.96: 10891096.

MalikIS, BhatiaVK, KoonerJS. 2001Cost effectiveness of ramipril treatment for cardiovascular risk reduction. Heart.85: 539543.

MarshallT. 2003Coronary heart disease prevention: Insights from modelling incremental cost effectiveness. BMJ.327: 1264.

ParrottS, GodfreyC. 2004Economics of smoking cessation. BMJ.328: 947949.

PharoahPD, HollingworthW. 1996Cost 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: 14431448.

ShepherdJ, CobbeSM, FordI, et al. 1995Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med.333: 13011307.

van HoutBA, SimoonsML. 2001Cost-effectiveness of HMG coenzyme reductase inhibitors; whom to treat? Eur Heart J.22: 751761.

WaldNJ, LawMR. 2003A strategy to reduce cardiovascular disease by more than 80%. BMJ.326: 1419.

WeismanSM, GrahamDY. 2002Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med.162: 21972202.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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