In this study, in which all available evidence from statin trials was simultaneously analyzed, the benefit of more intensive therapy was restricted to non-fatal events.
BackgroundStatins have proven efficacy in the reduction of cardiovascular events, but the
financial impact of its widespread use can be substantial.ObjectiveTo conduct a cost-effectiveness analysis of three statin dosing schemes in the
Brazilian Unified National Health System (SUS) perspective.MethodsWe developed a Markov model to evaluate the incremental cost-effectiveness ratios
(ICERs) of low, intermediate and high intensity dose regimens in secondary and
four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of
cardiovascular events. Regimens with expected low-density lipoprotein cholesterol
reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between
30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40%
(atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data
were obtained from a systematic review with 136,000 patients. National data were
used to estimate utilities and costs (expressed as International Dollars - Int$).
A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product
per capita (circa Int$11,770) was applied.ResultsLow dose was dominated by extension in the primary prevention scenarios. In the
five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The
ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY
in all scenarios. In the cost-effectiveness acceptability curves, intermediate
dose had a probability above 50% of being cost-effective with ICERs between Int$
9,000-20,000 per QALY in all scenarios.ConclusionsConsidering a reasonable WTP threshold, intermediate dose statin therapy is
economically attractive, and should be a priority intervention in prevention of
cardiovascular events in Brazil.
The aging of the population is a universal phenomenon with direct consequences
upon the public health system. One of the main repercussions of the growth in
this sector of the population is the increased prevalence of disorders such as
dementia and depression which are very frequent among the elderly. The
relationship between cardiovascular risk factors, dementia and depression have
been addressed in many recent investigations.ObjectivesTo evaluate the relationship of cognitive performance and depressive symptoms
with cardiovascular risk in the elderly.Methods94 high cardiovascular risk elderly patients and 160 healthy community
elderly were evaluated cross-sectionally. The Mini Mental State Examination
(MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main
measures. The cutoff for presence of depression was 6 on the GDS.ResultsThe high cardiovascular risk elderly group showed significantly lower scores
on the MMSE (p<0.001) and was significantly associated to depression
(p<0.001), independently of education. The logistic regression analysis
for depression as the dependent variable, age and group (healthy community
or high cardiovascular risk elderly) were kept in the final equation. Higher
age (Odds Ratio=0.92; 95% CI 0.86–0.98) and high cardiovascular risk elderly
(OR=2.99; 95% CI 1.36–6.59) were associated to depression.ConclusionsThe present findings corroborate the different cognitive performance of
elderly with high cardiovascular risk factors and the association of
depressive symptoms with this group.
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