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Can drug treatment prevent disease in common practice?

Arne Melander1, Gunnar Lindberg, J Lars G Nilsson

  • 1The NEPI Foundation, Malmø, Sweden. arne.melander@nepi.net

Zeitschrift Fur Arztliche Fortbildung Und Qualitatssicherung
|August 23, 2007
PubMed

Insights

Cardiovascular drug treatments for secondary prevention of myocardial infarction (MI) and stroke in high-risk individuals are effective and economical. However, primary prevention of MI or stroke in low-risk groups appears ineffective and costly.

Area of Science:

  • Cardiovascular medicine
  • Pharmacoeconomics
  • Preventive cardiology

Background:

  • Assessing the real-world effectiveness and economic viability of cardiovascular drug treatments is crucial for public health.
  • Common practice drug treatment efficacy requires evaluation beyond randomized clinical trials (RCTs).

Purpose of the Study:

  • To evaluate the effectiveness and cost-effectiveness of cardiovascular drug treatments in common practice.
  • To compare the Number Needed to Treat (NNT) in RCTs with Disease Impact Number (DIN) and Population Impact Number (PIN) in real-world settings.

Main Methods:

  • Analysis of four preventive cardiovascular randomized clinical trials (RCTs).
  • Calculation of 1-year NNT, DIN, and adjusted PIN, accounting for non-adherence.
  • Estimation of drug costs and general practitioner (GP) work time required to prevent one event.

Main Results:

  • Secondary prevention of MI with simvastatin and stroke prevention with antihypertensives in high-risk elderly were medically and economically effective (e.g., simvastatin: NNT=37, GP work time=2.7 years).
  • Primary prevention of MI with pravastatin and antihypertensives in low-risk individuals were found to be ineffective and expensive (e.g., low-risk antihypertensives: NNT=1667, GP work time=58.5 years).

Conclusions:

  • Cardiovascular drug treatments demonstrate significant effectiveness and economic benefits for secondary prevention and high-risk primary prevention.
  • Preventive drug therapies for low-risk populations appear to be medically and economically inefficient, necessitating careful consideration of treatment guidelines.

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