Abstract
Cardiovascular disease (CVD) is the leading cause of death internationally. We aimed to model the impact of CVD preventive double therapy (a statin and anti-hypertensive) by clinician-assessed absolute risk level. An established and validated multi-state life-table model for the national New Zealand (NZ) population was adapted. The new version of the model specifically considered the 60–64-year-old male population which was stratified by risk using a published NZ-specific CVD risk equation. The intervention period of treatment was for five years, but a lifetime horizon was used for measuring benefits and costs (a five-year horizon was also implemented). We found that for this group offering double therapy was highly cost-effective in all absolute risk categories (eg, NZ$1580 per QALY gained in the >20% in 5 years risk stratum; 95%UI: Dominant to NZ$3990). Even in the lowest risk stratum (≤5% risk in 5 years), the cost per QALY was only NZ$25,500 (NZ$28,200 and US$19,100 in 2018). At an individual level, the gain for those who responded to the screening offer and commenced preventive treatment ranged from 0.6 to 4.9 months of quality-adjusted life gained (or less than a month gain with a five-year horizon). Nevertheless, at the individual level, patient considerations are critical as some people may decide that this amount of average health gain does not justify taking daily medication.
Highlights
When intensive lipid lowering treatment is considered, it has been reported that this treatment is cost-effective in all groups
We aimed to model the impact of Cardiovascular disease (CVD) preventive pharmacotherapy by clinician-assessed absolute risk level and identify the associated health gain, impact on health system costs and cost-effectiveness for 60–64 year old males
We focused on double therapy as these preventive medicines are already widely used in this way in New Zealand and aspirin as a preventive pharmacotherapy is more controversial
Summary
When intensive lipid lowering treatment (relative to standard lipid lowering) is considered, it has been reported that this treatment is cost-effective in all groups (ie, in a study from the Netherlands – albeit this being for patients with established CVD5). Another study of the impact of tobacco tax increases in this country estimated very large health sector cost-savings, this model included impacts on reducing cancers and respiratory diseases along with CVD12 Given this background, we aimed to model the impact of CVD preventive pharmacotherapy by clinician-assessed absolute risk level and identify the associated health gain, impact on health system costs and cost-effectiveness for 60–64 year old males. We aimed to model the impact of CVD preventive pharmacotherapy by clinician-assessed absolute risk level and identify the associated health gain, impact on health system costs and cost-effectiveness for 60–64 year old males We selected this age-group as just an initial starting point for future work on assessing this approach of considering absolute CVD risk. We focused on double therapy (a combination of a statin and an anti-hypertensive) as these preventive medicines are already widely used in this way in New Zealand and aspirin as a preventive pharmacotherapy is more controversial
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