Kostnader og leveårsgevinster ved medikamentell primærforebygging av hjertekarsykdom

Abstract

BACKGROUND Cardiovascular disease (CVD) has for decades been the most common cause of death in Norway and most other Western countries. Several groups of drugs have shown in clinical trials to prevent CVD. In this report, we have evaluated the cost-effectiveness of these drugs.

METHODS Based on a model of the progression of CVD from healthy to death, we explored which drugs that might be cost-effective. Analyses were conducted both compared to no treatment and between different drugs. Analyses were conducted on different risk levels and in different age groups for both men and women. We also performed probabilistic sensitivity analyses. Our analyses were accompanied by a systematic review of other economic evaluations of preventive strategies against CVD.

RESULTS Calcium channel blockers, thiazides, beta blockers, aspirin and statins were all cost-effective compared to no treatment for all groups of men and women in age groups between 40 and 69. The life year gains for each of the drugs varied between 3 and 17 months. Calcium channel blockers and thiazides were the most cost-effective combination of two antihypertensive drugs. In the base case analyses, the combination of calcium channel blockers, thiazides and ACE-inhibitors was the most cost-effective combination of three drugs. The sensitivity analyses indicate considerable uncertainty related to the question of which was the most cost-effective of the antihypertensive drugs. Whether treatment was cost-effective compared to no treatment was concerned with less uncertainty. Our systematic review of other economic evaluations showed considerable discrepancies between analyses of prevention strategies against CVD.

DISCUSSION The results of this study indicate that statins, several antihypertensives and aspirin are cost-effective in all analysed groups between 40 and 69 years old. It is worthwhile noting, however, that the model is built on numerous assumptions, and this introduces considerable uncertainty with respect to optimal choice of therapies.