ArticleBMJ (Clinical research ed.)2003
Coronary heart disease prevention: insights from modelling incremental cost effectiveness.
Article in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Review
- Why is my hypertensive patient still not controlled?High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2015Article
- Article
- Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice.Journal of human hypertension · 2009Article
- Predicting the effectiveness of prevention: a role for epidemiological modeling.The journal of primary prevention · 2008Article
- Prescription drug expenditures and population demographics.Health services research · 2006Article
- The polypill: at what price would it become cost effective?Journal of epidemiology and community health · 2006Article
- Underutilization of aspirin persists in US ambulatory care for the secondary and primary prevention of cardiovascular disease.PLoS medicine · 2005Article
- [Primary prevention of coronary heart disease? What is cost effective in the clinical practice?].Zeitschrift fur Kardiologie · 2005Article
- The case for statins: has it really been made?Journal of the Royal Society of Medicine · 2004Article
- Treating hypertension with guidelines in general practice.BMJ (Clinical research ed.) · 2004Article
- Prevention of coronary heart disease: incremental cost effectiveness raises issues.BMJ (Clinical research ed.) · 2004Article
- Prevention of coronary heart disease: statins are even less effective than paper shows.BMJ (Clinical research ed.) · 2004Article
- Prevention of coronary heart disease: is a cure too expensive?BMJ (Clinical research ed.) · 2004Article
- Prevention of coronary heart disease: data in table 2 could be shown more explicitly for better understanding.BMJ (Clinical research ed.) · 2004Article
- What do we gain from the sixth coronary heart disease drug?BMJ (Clinical research ed.) · 2003Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine which treatments for preventing coronary heart disease should be offered to which patients by assessing their incremental cost effectiveness.
designModelling study. DATA SOURCES: Cost estimates (for NHS) and estimates of effectiveness obtained for aspirin, antihypertensive drugs, statins and clopidogrel. DATA SYNTHESIS: Treatment effects were assumed to be independent, and cost per coronary event prevented was calculated for treatments individually and in combination across patients at a range of coronary risks.
resultsThe most cost effective preventive treatments are aspirin, initial antihypertensive treatment (bendrofluazide and atenolol), and intensive antihypertensive treatment (bendrofluazide, atenolol and enalapril), whereas simvastatin and clopidogrel are the least cost effective (cost per coronary event prevented in a patient at 10% coronary risk over five years is 3500 pounds sterling for aspirin, 12 500 pounds sterling for initial antihypertensives, 18 300 pounds sterling for intensive antihypertensives, 60 000 pounds sterling for clopidogrel, and 61 400 pounds sterling for simvastatin). Aspirin in a patient at 5% five year coronary risk costs less than a fifth as much per event prevented (7900 pounds sterling) as simvastatin in a patient at 30% five year risk (40 800 pounds sterling). DISCUSSION: A cost effective prevention strategy would offer aspirin and initial antihypertensive treatment to all patients at greater than 7.5% five year coronary risk before offering statins or clopidogrel to patients at greater than 15% five year coronary risk. Incremental cost effectiveness analysis of treatments produces robust, practical cost effectiveness rankings that can be used to inform treatment guidelines.
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