Cost-effectiveness of primary and secondary prevention in cardiovascular diseases

INTRODUCTION, AIMS, AND METHODS: Industrial countries' societies are challenged to counter the increasing costs of health care. The preponderance of cardiovascular diseases in middle-aged people demands new strategies to reduce the extremely high rates of early deaths and increased morbidity and thus to avert considerable costs. Prevention programmes are appropriate means to combine therapeutic needs with health economic goals. A review of techniques of economic evaluation is given, from which a critical appraisal of cost-effectiveness analyses in primary and secondary prevention with HMG-CoA reductase inhibitors in coronary heart disease follows. Our own analysis of cost-effectiveness of primary prevention based on the clinical results of the WOSCOP study is also presented.

Long-term treatment with HMG-CoA reductase inhibitors is effective (30% mortality reduction), safe and tolerable. With a cost-effectiveness ratio of DM15,000-25,000/life-year saved ($9000-15,000) it can be recommended for secondary prevention. The application of statins in primary prevention has also proved to be clinically effective. But with a cost-effectiveness ratio of DM330,000/life-year saved ($195,000) they cannot be generally advocated in patients with hypercholesterolaemia. However, the treatment has to be considered for high risk patients. Aspirin prevention seems to be an alternative in patients without additional risk factors.