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Preventive Pharmacotherapy for Cardiovascular Disease: A Modelling Study Considering Health Gain, Costs, and
Nhung Nghiem1, Josh Knight2,3, Anja Mizdrak4
1BODE3 Programme, University of Otago, Wellington, New Zealand. nhung.nghiem@otago.ac.nz.
Insights
Implementing cardiovascular disease (CVD) preventive double therapy, combining statins and anti-hypertensives, is highly cost-effective for 60-64-year-old males across all risk levels in New Zealand.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Economics
Background:
- Cardiovascular disease (CVD) remains the leading global cause of mortality.
- Preventive therapies, including statins and anti-hypertensives, are crucial for mitigating CVD risk.
- Assessing the cost-effectiveness of combined preventive therapies stratified by absolute risk is essential for resource allocation.
Purpose of the Study:
- To model the impact and cost-effectiveness of CVD preventive double therapy (statin and anti-hypertensive) in New Zealand (NZ) males aged 60-64.
- To stratify the analysis by clinician-assessed absolute CVD risk levels.
- To evaluate benefits and costs over both five-year and lifetime horizons.
Main Methods:
- Adaptation of an established multi-state life-table model for the NZ population.
- Stratification of the 60-64-year-old male population by CVD risk using a published NZ-specific risk equation.
- Simulation of a five-year intervention period with lifetime and five-year horizon analyses for benefits and costs.
Main Results:
- Double therapy was found to be highly cost-effective across all absolute risk categories.
- Cost per Quality-Adjusted Life Year (QALY) gained ranged from NZ$1580 (for >20% risk) to NZ$25,500 (for ≤5% risk).
- Individual health gains ranged from 0.6 to 4.9 months of quality-adjusted life, varying by risk stratum and time horizon.
Conclusions:
- Offering CVD preventive double therapy to 60-64-year-old NZ males is a cost-effective strategy, even in lower absolute risk groups.
- While average health gains are modest at the individual level, the population-level benefits and cost-effectiveness are significant.
- Individual patient preferences and considerations regarding daily medication are important factors in treatment decisions.
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.
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