Primary prevention of cardiovascular disease: Cost-effectiveness comparison

Franco, Oscar H.; Kinderen, Arno J. der; Laet, Chris De; Peeters, Anna; Bonneux, Luc

doi:10.1017/s0266462307051598

Cited by 44 publications

(32 citation statements)

References 26 publications

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“…However, inconsistencies exist at lower levels. [6,7,36] Franco et al [9,37] reviewed 24 studies of costeffectiveness analyses of statins. Estimated ratios increase with decreasing risk.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] For instance, a previous study on the cost effectiveness of four risklowering interventions (smoking cessation, antihypertensives, aspirin [acetylsalicylic acid], and statins) in the primary prevention of cardiovascular disease showed statins to be the least cost effective (h73 971 to h190 276 per year of life saved). [9] Statin therapy has also been shown to be cost effective for high levels of CHD risk, but inconsistencies exist at lower levels. [10] Finally, several guidelines regarding management of subjects with high CHD risk have been issued but, to our knowledge, their economic impact has never been compared.…”

Section: Introductionmentioning

confidence: 99%

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Statins for Cardiovascular Prevention According to Different Strategies

Ito

Nanchen

Rodondi

et al. 2011

American Journal Cardiovascular Drugs

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“…However, inconsistencies exist at lower levels. [6,7,36] Franco et al [9,37] reviewed 24 studies of costeffectiveness analyses of statins. Estimated ratios increase with decreasing risk.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Statins for Cardiovascular Prevention According to Different Strategies

Ito

Nanchen

Rodondi

et al. 2011

American Journal Cardiovascular Drugs

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show abstract

“…[7][8][9][10][11][12][13][14][15] A decision analysis reported that routine use of low-dose aspirin is as likely to be associated with benefit as harm, but that analysis was limited to elderly people without cardiovascular disease. 8 Previous cost-effectiveness analyses that examined the threshold to recommend aspirin reported that its use was warranted from a 10-year cardiovascular disease risk that varied between 7.5% and 15%.…”

Section: Discussionmentioning

confidence: 99%

“…Previous decision analyses and economic evaluations have shown that the decision of whether to take aspirin as the primary prevention for cardiovascular events depends on the patients' cardiovascular risk level. [7][8][9][10][11][12][13][14][15] Recently, a meta-analysis of the role of aspirin in the primary prevention of cardiovascular events revealed important differential effects of aspirin therapy between men and women. 5 Aspirin reduced the risk of myocardial infarction in men and that of ischemic stroke in women.…”

Section: Editorial P 2844 Clinical Perspective P 2883mentioning

confidence: 99%

Cost-Effectiveness of Aspirin Treatment in the Primary Prevention of Cardiovascular Disease Events in Subgroups Based on Age, Gender, and Varying Cardiovascular Risk

et al. 2008

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Background-Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular disease risk. Methods and Results-A Markov model was developed to predict the number of cardiovascular events prevented, quality-adjusted life-years, and costs over a 10-year period. Event rates were taken from Dutch population data, and the relative effectiveness of aspirin was taken from a gender-specific meta-analysis. Sensitivity analyses and Monte Carlo simulations were conducted to evaluate the robustness of the results. In 55-year-old persons, aspirin prevented myocardial infarctions in men (127 events per 100 000 person-years) and ischemic strokes in women (17 events per 100 000 person-years). Aspirin implies a net investment and a quality-adjusted life-year gain in men 55 years of age; the incremental cost-effectiveness ratio was 111 949 euros per quality-adjusted life-year (1 euroϭ$1.27 as of June 2007). Aspirin was cost-effective for 55-and 65-year-old men with moderate cardiovascular risk and men 75 years of age (10-year cardiovascular disease risk Ͼ10%). Conversely, aspirin was beneficial for women 65 years of age with high cardiovascular risk and women 75 years of age with moderate cardiovascular risk (10-year cardiovascular disease risk Ͼ15%). Results were sensitive to drug treatment costs, effectiveness of aspirin treatment, and utility of taking aspirin. Conclusions-Aspirin treatment for primary prevention is cost-effective for men with a 10-year cardiovascular disease risk of Ͼ10% and for women with a risk of Ͼ15%. This occurs much later in life for women than men. Therefore, opportunities for the primary prevention of aspirin seem limited in women, and a differentiated preventive strategy seems warranted.

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“…4 Smoking cessation has also been found to be A call to action: new treatment options provide even more reasons to intervene in tobacco dependence Robert the most cost-effective therapy for the primary prevention of CVD in men compared with aspirin, antihypertensives, and statins. 5 Although it should be obvious to cardiologists that a combination of pharmacotherapy and counseling is the best way to help their patients stop smoking, survey data indicate that many of these practitioners might not be effectively intervening in this pernicious addiction. A European study indicated that cardiovascular specialists are reluctant to take the time to intervene in tobacco dependence, and are less likely than lung physicians to advise their patients to stop smoking and to prescribe medications to treat tobacco dependence.…”

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confidence: 99%

A call to action: new treatment options provide even more reasons to intervene in tobacco dependence

Anthenelli

2007

Nat Rev Cardiol

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There is both good and bad news in the global battle against tobacco addiction. On a positive note, public health efforts, including improved use of pharmacologic and behavioral interventions, have helped reduce the prevalence of tobacco smoking in most developed countries.Smoking cessation initiatives in undeveloped countries, however, lag far behind. Smoking now contributes to 5 million deaths globally each year, and this somber statistic is expected to double by 2020. 1 Much of the morbidity and mortality associated with cigarette smoking is caused by cardiovascular disease (CVD). I believe that specialists treating CVD must be more proactive and persistent in motivating smoking cessation in their patients, and make use of combined pharmacologic and behavioral interventions to facilitate this end. The rationale behind this call to action stems from the fact that patients with CVD have a greater need to stop smoking than the average smoker, and because physicians managing CVD have never been better equipped to assist their patients with smoking cessation.Smoking is a classical risk factor for CVD, along with hypertension, the dyslipidemias, obesity, and type 2 diabetes mellitus, and it is estimated that up to 35% of tobacco-related deaths in developed countries have cardiovascular causes. 2 There is compelling evidence that cigarette smoking contributes to CVD through a host of pathways, including stiffening of the vascular beds, promoting insulin resistance and inflammation, and abetting plaque and thrombus formation. 3 Moreover, there is a complex interaction between smoking and other classical and nonclassical (e.g. visceral adiposity, hypoadiponectinemia) risk factors. Patients who smoke are, therefore, prone to multiple cardiovascular risk factors and are at the greatest risk of premature death from CVD. Not surprisingly, smoking cessation reverses this threat; the excess risk of coronary heart disease is reduced by 50% among ex-smokers 1 year after quitting. 4 Smoking cessation has also been found to be

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Primary prevention of cardiovascular disease: Cost-effectiveness comparison

Cited by 44 publications

References 26 publications

Statins for Cardiovascular Prevention According to Different Strategies

Statins for Cardiovascular Prevention According to Different Strategies

Cost-Effectiveness of Aspirin Treatment in the Primary Prevention of Cardiovascular Disease Events in Subgroups Based on Age, Gender, and Varying Cardiovascular Risk

A call to action: new treatment options provide even more reasons to intervene in tobacco dependence

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