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Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010.
QJM. 2007 May; 100(5):277-89.QJM

Abstract

BACKGROUND

Coronary heart disease (CHD) in the UK affects approximately 3 million people, with >100,000 deaths annually. Mortality rates have halved since the 1980s, but annual NHS treatment costs for CHD exceed 2 billion pounds.

AIM

To examine the cost-effectiveness of specific CHD treatments in England and Wales.

METHODS

The IMPACT CHD model was used to calculate the number of life-years gained (LYG) from specific cardiological interventions from 2000 to 2010. Cost-effectiveness ratios (costs per LYG) were generated for each specific intervention, stratified by age and sex. The robustness of the results was tested using sensitivity analyses.

RESULTS

In 2000, medical and surgical treatments together prevented or postponed approximately 25,888 deaths in CHD patients aged 25-84 years, thus generating approximately 194,929 extra life-years between 2000 and 2010 (range 143,131-260,167). Aspirin and beta-blockers for secondary prevention following myocardial infarction or revascularisation, for angina and heart failure were highly cost-effective (< 1000 pounds per LYG). Other secondary prevention therapies, including cardiac rehabilitation, ACE inhibitors and statins, were reasonably cost-effective (1957 pounds, 3398 pounds and 4246 pounds per LYG, respectively), as were CABG surgery (3239 pounds-4601 pounds per LYG) and angioplasty (3845 pounds-5889 pounds per LYG). Primary angioplasty for myocardial infarction was intermediate (6054 pounds-12,057 pounds per LYG, according to age), and statins in primary prevention were much less cost-effective (27,828 pounds per LYG, reaching 69,373 pounds per LYG in men aged 35-44). Results were relatively consistent across a wide range of sensitivity analyses.

DISCUSSION

The cost-effectiveness ratios for standard CHD treatments varied by over 100-fold. Large amounts of NHS funding are being spent on relatively less cost-effective interventions, such as statins for primary prevention, angioplasty and CABG surgery. This merits debate.

Authors+Show Affiliations

Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17449875

Citation

Fidan, D, et al. "Economic Analysis of Treatments Reducing Coronary Heart Disease Mortality in England and Wales, 2000-2010." QJM : Monthly Journal of the Association of Physicians, vol. 100, no. 5, 2007, pp. 277-89.
Fidan D, Unal B, Critchley J, et al. Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010. QJM. 2007;100(5):277-89.
Fidan, D., Unal, B., Critchley, J., & Capewell, S. (2007). Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010. QJM : Monthly Journal of the Association of Physicians, 100(5), 277-89.
Fidan D, et al. Economic Analysis of Treatments Reducing Coronary Heart Disease Mortality in England and Wales, 2000-2010. QJM. 2007;100(5):277-89. PubMed PMID: 17449875.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010. AU - Fidan,D, AU - Unal,B, AU - Critchley,J, AU - Capewell,S, Y1 - 2007/04/21/ PY - 2007/4/24/pubmed PY - 2008/1/26/medline PY - 2007/4/24/entrez SP - 277 EP - 89 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 100 IS - 5 N2 - BACKGROUND: Coronary heart disease (CHD) in the UK affects approximately 3 million people, with >100,000 deaths annually. Mortality rates have halved since the 1980s, but annual NHS treatment costs for CHD exceed 2 billion pounds. AIM: To examine the cost-effectiveness of specific CHD treatments in England and Wales. METHODS: The IMPACT CHD model was used to calculate the number of life-years gained (LYG) from specific cardiological interventions from 2000 to 2010. Cost-effectiveness ratios (costs per LYG) were generated for each specific intervention, stratified by age and sex. The robustness of the results was tested using sensitivity analyses. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 25,888 deaths in CHD patients aged 25-84 years, thus generating approximately 194,929 extra life-years between 2000 and 2010 (range 143,131-260,167). Aspirin and beta-blockers for secondary prevention following myocardial infarction or revascularisation, for angina and heart failure were highly cost-effective (< 1000 pounds per LYG). Other secondary prevention therapies, including cardiac rehabilitation, ACE inhibitors and statins, were reasonably cost-effective (1957 pounds, 3398 pounds and 4246 pounds per LYG, respectively), as were CABG surgery (3239 pounds-4601 pounds per LYG) and angioplasty (3845 pounds-5889 pounds per LYG). Primary angioplasty for myocardial infarction was intermediate (6054 pounds-12,057 pounds per LYG, according to age), and statins in primary prevention were much less cost-effective (27,828 pounds per LYG, reaching 69,373 pounds per LYG in men aged 35-44). Results were relatively consistent across a wide range of sensitivity analyses. DISCUSSION: The cost-effectiveness ratios for standard CHD treatments varied by over 100-fold. Large amounts of NHS funding are being spent on relatively less cost-effective interventions, such as statins for primary prevention, angioplasty and CABG surgery. This merits debate. SN - 1460-2725 UR - https://www.unboundmedicine.com/medline/citation/17449875/Economic_analysis_of_treatments_reducing_coronary_heart_disease_mortality_in_England_and_Wales_2000_2010_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcm020 DB - PRIME DP - Unbound Medicine ER -