The cost-effectiveness of drug treatments for primary prevention of cardiovascular disease: a modelling study.
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.


METHODS
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.
Marshall
Tom
T
Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK. T.P.Marshall@bham.ac.uk
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004739:England; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D018803:Models, Economic; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011322:Primary Prevention / Q000191:economics*; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors