title: Identifying favorable-value cardiovascular health services.
abstract: OBJECTIVE
  To identify cardiovascular health services with a high level of evidence to suggest that they deliver favorable value.
  
  
  METHODS
  Evidence synthesis using the Cost-Effectiveness Analysis Registry.
  
  
  METHODS
  We queried the registry to identify published cost-effectiveness analyses of cardiovascular health services in the United States. In addition to searching the registry, we performed supplementary searches of published literature for cost-effectiveness studies of cardiovascular interventions that were endorsed by guidelines of national medical and scientific societies. We defined favorable value as an incremental cost-effectiveness ratio of $100,000 or less per quality-adjusted life-year.
  
  
  RESULTS
  Our initial review of cardiovascular health services in the United States revealed 174 separate peer-reviewed studies. Of those, 157 studies did not meet our inclusion criteria, leaving 17 studies for further evaluation that covered the following services with potentially high value: statins to prevent myocardial infarction (for primary and secondary prevention), screening for and treatment of high blood pressure (diuretics or beta-blockers and angiotensin-converting enzyme inhibitors in the case of diabetes) to prevent myocardial infarction and stroke, warfarin sodium and low-molecular-weight heparin to prevent pulmonary emboli, implantable cardiac defibrillators for patients at high risk of sudden death, antiplatelet drugs (aspirin and clopidogrel bisulfate) to prevent future myocardial infarction, beta-blockers for patients who have had myocardial infarction, warfarin to prevent future stroke in persons with nonvalvular atrial fibrillation, and percutaneous procedures to relieve claudication symptoms.
  
  
  CONCLUSIONS
  We describe a new way of synthesizing cost-effectiveness evidence for use by consumers, payers, and other decision makers.
authors.affiliation: Section of Value and Comparative Effectiveness, Division of General Internal Medicine, NYU School of Medicine, 423 E 23rd Street, New York, NY 10010, USA. scott.braithwaite@nyumc.org
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Mentor
mesh_terms: D002317:Cardiovascular Agents / Q000191:economics / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000191:economics* / Q000379:methods / Q000592:standards; D006296:Health Services / Q000191:economics* / Q000592:standards; D006801:Humans; D019057:Quality-Adjusted Life Years; D012042:Registries / Q000706:statistics & numerical data; D014481:United States
chemical_list: D002317:Cardiovascular Agents