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The cost effectiveness of treatments for coronary heart disease varies more than 100-fold, a new study shows.
It found that the cost for each life year gained of aspirin and ß blockers for secondary prevention after a heart attack worked out at less than £1000 (€1500; $2000), whereas the cost of statins used for primary prevention in men aged 35–44 was around £70000 (Quarterly Journal of Medicine 2007;100:277-89).
“Large amounts of NHS funding are being spent on relatively less cost effective interventions, such as statins for primary prevention, angioplasty, and coronary artery bypass graft surgery. This merits debate,” say the authors, from the University of Liverpool and Liverpool School of Tropical Medicine.
They estimated that, in 2000, medical and surgical treatments prevented or postponed 25888 deaths in patients with coronary heart disease aged 25-84 years, generating 194929 extra life years between 2000 and 2010 (range 143131 to 260167).
In the study the authors, who say that the annual cost to the NHS of treatment for coronary heart disease exceed £2bn, estimated the number of life years gained from 2000 to 2010 for individual treatment categories.
The main categories they looked at were acute myocardial infarction, secondary prevention after acute myocardial infarction or revascularisation, unstable angina, chronic angina, heart failure in hospital and in the community, and primary prevention using statins.
Individual treatments examined included aspirin, thrombolysis, ß blockers, angiotensin converting enzyme (ACE) inhibitors, statins, cardiac rehabilitation, warfarin, heparin, glycoprotein IIb/IIIa inhibitors, coronary artery bypass graft surgery, and angioplasty.
Their results show that aspirin and ß blockers for secondary prevention after myocardial infarction or revascularisation for angina and for heart failure were highly cost effective at less than £1000 per life year gained.
Other secondary prevention treatments, including cardiac rehabilitation, ACE inhibitors, and statins, were reasonably cost effective (at £1957, £3398, and £4246 per life year gained, respectively), as were coronary artery bypass graft surgery (£3239 to £4601) and angioplasty (£3845 to £5889).
Primary angioplasty for myocardial infarction was intermediate (£6054 to £12057, depending on age), and statins in primary prevention were much less cost effective (£27828, but as much as £69373 in men aged 35–44).
Aspirin, ß blockers, and spironolactone all proved highly cost effective in the treatment of chronic heart failure—for patients who were initially admitted to hospital as well as for those treated in the community. Cost effectiveness was consistently less than £700 per life year gained across all age groups.
“Coronary heart disease funding in the NHS currently seems to emphasise revascularisation and waiting lists,” the authors say. “Over 90% of national service framework monies have been spent on pathways to revascularisation (promoting referral and assessment) and on the high cost procedures themselves.
“However, in the UK as in other countries, secondary prevention and heart failure therapies still consistently offer better value for money than coronary artery bypass graft surgery, angioplasty, or statins.”