Cost-effectiveness Of Primary Prevention Research Articles

Prevention and treatment of neutropenia in routine clinical practice. How to improve the quality of cancer care and reduce treatment costs?

Neutropenia is a common complication during anti-cancer therapy. Risk factors for febrile neutropenia, its diagnostic criteria, and methods of its prevention and treatment have been well described. In this article, we demonstrated the need to assess cost effectiveness of primary prevention of complications associated with polychemotherapy and treatment of neutropenia, as well as the need to analyze their incidence. Individual risk assessment of febrile neutropenia, implementation of the antimicrobial drug registry, and administration of pegylated granulocyte colony-stimulating factor reduced the incidence of neutropenia, its duration, and the number of antimicrobial drugs used. This, in turn, improved the quality of healthcare and optimized the use of hospital resources.

Cost-Effectiveness of Primary Prevention with Statin Treatment for Chinese Patients with Type 2 Diabetes.

Statins can reduce the risk of cardiovascular events in patients with diabetes. The objective of this analysis was to evaluate whether primary prevention with statin treatment is cost-effective for newly diagnosed type 2 diabetes mellitus (T2DM) patients in the Chinese context. An economic analysis of primary prevention with statin treatment was conducted using the Chinese Outcomes Model for T2DM with a time horizon of a lifetime, which was developed and validated based on the Chinese population. Clinical costs and utility inputs were gathered from published sources. Lifetime discounted quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER) were measured. The uncertainty was evaluated by one-way and probabilistic sensitivity analyses. Statin treatment with atorvastatin 10mg could add 0.08 QALYs with an additional $1676 compared with that of no statin management (control strategy) over a lifetime horizon, which led to an ICER of $21,924 per QALY gained. At a willingness-to-pay threshold of $27,351 per QALY gained, there was an approximately 80% probability of statin treatment being cost-effective compared with the control strategy. The model outcomes were most sensitive to the length of the expected life and age at the T2DM diagnosis. Statin treatment with atorvastatin is most likely cost-effective for primary prevention in Chinese patients newly diagnosed with type 2 diabetes. Partially funded by Pfizer Inc.

PRIMARY PREVENTION OF MYOCARDIAL INFARCTION IN MIDDLE-AGED MALES (15-YEAR FOLLOW-UP): CLINICAL AND ECONOMIC ASPECTS OF THE PROBLEM

Aim. To estimate incidence rate of first myocardial infarction (MI) with different outcomes and factors, it is influenced by, depending on the intensity of preventive measures in a population of middle-aged men during 15-year follow-up; to evaluate economic efficiency of primary medical prevention. Material and methods. Two populations of middle-aged men with a total of 6656 males (3488 men the group of active prevention and 3168 the group of comparison) were followed up over 15 years. Results. The group of active prevention revealed 22.1% reduced MI incidence rate during 5-year follow-up as compared to the second group, fatal MI incidence rate was 42.4% lower, p 0.05), while patients with clinical signs of ischemic heart disease (IHD) and no history of previous MI kept significant distinctions in first MI incidence rate (41% less in the first group, p<0.05). First MI incidence for the 10-year period was the least at risk factors (RF) absence and twice higher even at single RF presence. Combination of RF caused 4-5 fold increase in risk for MI. Life status of 81.3% of the enrolled men (5410 of 6656) followed over 15 years was received along with the monitoring of prognosis. Such indices as “life years saved” (LYS) and “quality-adjusted life years saved” (QALYS) for 1000 persons in the active prevention group were 53 and 51 years, respectively during the 5-year follow-up, 147 and 143 years – during the 10-year follow-up. In the long-term actual expenses for 1 LYS were 3.4-fold less than annual gross domestic product (GDP) value, at that charges for primary prevention – 4-fold less, which has been for the first time demonstrated using factual data and not mathematic modeling usually used in scientific literature. Conclusion. The long-term prospective follow-up has demonstrated that the risk of first MI can be reduced by means of active and systematic prevention. Cost-effectiveness of primary prevention, including the one of MI, has been conclusively showed. The results allowed to validate the reasonability of active multifactorial prevention in the settings of primary healthcare, which makes it possible to define scientific-based recommendations for real practice.

Ökonomische Aspekte der Prävention: Eine internationale Perspektive

This article provides an overview of selected economic aspects of primary prevention, from an international perspective. It starts by qualifying two widely held myths about the economics of prevention. It then discusses two core components of the economic argument for (or against) prevention: first, this involves providing a very basic, efficiency-based rationale for a role of government in prevention; second, we review the existing evidence on the cost-effectiveness of primary prevention. While a fair amount of encouraging evidence exists, there has definitely been far more cost-effectiveness research on clinical than on non-clinical primary prevention (e. g., health promotion). The article seeks to explain this comparative shortage, which carries over to pure effectiveness research on prevention. It concludes by arguing the economic case for a role of government not only in prevention but also, and even more so, in research on non-clinical prevention.

W16-P-018 Cost-effectiveness of primary prevention of CVD from the UK NHS perspective: A titrating-dose model for patients on statin therapy at moderate risk

W16-P-018 Cost-effectiveness of primary prevention of CVD from the UK NHS perspective: A titrating-dose model for patients on statin therapy at moderate risk

W16-P-017 Cost-effectiveness of primary prevention of CVD from the UK NHS perspective: A comparison of men and women with type 2 diabetes

W16-P-017 Cost-effectiveness of primary prevention of CVD from the UK NHS perspective: A comparison of men and women with type 2 diabetes

The relationship between cholesterol and stroke: implications for antihyperlipidaemic therapy in older patients.

Various studies on the relationship between serum cholesterol level and the risk of stroke have been published recently. Subsequent reviews have extrapolated information on stroke from the clinical trials originally aimed at lowering cholesterol for the primary and secondary prevention of myocardial infarction (MI) in middle-aged patients. We have reviewed the epidemiological knowledge on the relationship between serum cholesterol levels and stroke, and also focused on possible reduction of the risk of stroke with hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor treatment. Possible benefits from such therapy are particularly relevant for the elderly population which is at particularly high risk for stroke. The effects of serum cholesterol levels on the risk for haemorrhagic and ischaemic stroke have been evaluated. Indirect epidemiological evidence indicates that serum levels of total cholesterol and its subfractions are determinants of stroke, but their associations are relatively weak. When exploring the possible association of serum cholesterol levels with the increased risk of stroke with aging, we concluded that, as in younger adults, elevated total cholesterol and decreased high density lipoprotein-cholesterol levels predispose to ischaemic stroke in the elderly. The mechanism through which serum cholesterol levels increase stroke risk is based on its actions on the artery walls. Indirect evidence suggests that the reduction in the stroke risk with HMG-CoA reductase inhibitors is larger than would be expected with reduction of elevated serum cholesterol level alone. Therefore, antioxidant and endothelium-stabilising properties of HMG-CoA reductase inhibitors may contribute in reducing the risk of stroke in recipients. Lowering high serum cholesterol with HMG-CoA reductase inhibitors has been beneficial in the primary and secondary prevention of MI. No trials have specifically tested the effect of cholesterol lowering with HMG-CoA reductase inhibitors on stroke occurrence. High serum cholesterol levels are a risk factor for ischaemic stroke, although the risk imparted is lower than that for MI. Although the relative risk of stroke associated with elevated serum cholesterol levels is only moderate, its population attributable risk is high given the increase in the elderly population worldwide. The effect of cholesterol reduction with HMG-CoA reductase inhibitors on prevention of ischaemic stroke should be evaluated in prospective, randomised, placebo-controlled trials in the elderly. The tolerability of lipid-lowering drugs in the elderly and the cost effectiveness of primary prevention of stroke using lipid-lowering drugs also needs to be assessed in the elderly.

CVB5 Preventing Cardiovascular Disease: Is Primary Prevention with Pravastatin Worth the Money?

Addition of pravastatin to dietary advice has been shown by the West of Scotland Coronary Prevention Study (WOSCOPS) to prevent the transition from health to cardiovascular disease. METHODS: An economic analysis was coducted to assess the cost-effectiveness of primary prevention with pravastatin. Appropriate Canadian risk factor data were used in an exponential regression model derived from WOSCOPS data to estimate the rates at which Canadians transition to cardiovascular disease. The number of transitions avoided were valued in terms of cost savings to the Canadian health care system, as well as life years gained. Canadian cost (1996 CAD $1 =$0.72 US) were based on ICD-9-CM Ontario Case Cost Project inpatient hospital data and were discounted at 5% per annum beyond the first year. The difference between age and gender-specific Canadian life table survival and post-event survival obtained from Scottish linkage data was calculated to estimate life years gained. RESULTS: The prevention of 303 transitions to CVD, which implies 3,067 years of life gained, would be achieved if 10,000 Candian hypercholesterolaemic men started treatment. Based on these results, cost-effectiveness ratios of $10,113/LYG (undiscounted) and $24,223/LYG (discounted) were obtained. If only high-risk patients (defined by published consensus statements) are treated, the ratios drop to between $6,865 and $16,391. CONCLUSION: In light of published Canadian economic analysis guidelines, this constitutes strong evidence for adoption of primary prevention with pravastatin to avoid the clinical manifestations of CVD.

Strategies for the management of hypercholesterolaemia: a systematic review of the cost-effectiveness literature.

To review research addressing the management of cholesterol in the prevention of coronary heart disease in order to assess the cost-effectiveness of such interventions. A systematic review of economic evaluations identified through searches of MEDLINE and the Social Sciences Citation Index revealed 38 studies addressing the cost-effectiveness of cholesterol management. They were distinguished according to screening approaches, dietary advice and drug treatment. Most studies were not associated directly with clinical trial results, but adopted economic modelling approaches. Whilst there is general agreement among the majority of analyses, studies of cholesterol management concerned with screening strategies were extremely sensitive to changes in their assumptions; so much so that only a limited emphasis may be placed on specific cost-effectiveness ratios and the conclusions drawn from them. All studies considered direct costs, though many were limited to drug costs. The cost-effectiveness of primary prevention by cholesterol-lowering drugs is highly variable, depending on age at initiation of treatment and cardiovascular risk profile. Pharmacological intervention is least cost-effective in the young and the elderly. The cost-effectiveness of cholesterol-reducing agents improves when they are targeted at those at high risk. HMG-CoA reductase inhibitors are generally more effective and more cost-effective at reducing cholesterol-related coronary events than other medications. The methods and economic data upon which these studies are based need to be improved if robust policy conclusions are to be formulated.

Cost-effectiveness analysis in heart disease, part II: Preventive therapies

Cost-effectiveness analysis of preventive therapies are reviewed in the following categories: lipid lowering, hypertension, smoking cessation, exercise, and anticoagulation. From review of 8 analyses, cost-effectiveness of primary prevention via cholesterol lowering drugs is generally expensive, whereas that of secondary prevention generally is favorable. However, targeting by age, coexisting risk factors, and gender strongly influence results that are also sensitive to drug costs. Treatment of hypertension (5 analyses) is cost-effective in virtually all patient populations and circumstances and for a wide variety of drugs. It is more so with coexisting risk. Issues relating to compliance and drug costs are important. Smoking cessation (4 analyses) is highly cost-effective and worthwhile. However, data on recidivism are incomplete, and cessation may be more difficult to achieve in the general population versus study patients. In one analysis, an exercise program was found to be cost-effective in prevention of coronary heart disease. Anticoagulants have been analyzed in various circumstances. Their cost-effectiveness is favorable for prosthetic valves, although sensitive to imprecision in monitoring. It is also favorable for mitral stenosis in the presence of atrial fibrillation but not normal sinus rhythm. Cost-effectiveness of heparinization for prosthetic valve patients undergoing surgery is rather variable and depends on type of surgery (major versus minor) and type of valve. Many topics in anticoagulant therapy remain to be explored from a cost-effectiveness point of view.