Primary prevention of cardiovascular disease: cost-effectiveness comparison

OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease. METHODS: Using data from the Framingham Heart Study and the Framingham Offspring study, we built life tables to model the benefits of the selected interventions. Participants were classified by age and level of risk of coronary heart disease. The effects of risk reduction are obtained as numbers of death averted and life-years saved within a 10-year period. Estimates of risk reduction by the interventions were obtained from meta-analyses and costs from Dutch sources. RESULTS: The most cost-effective is smoking cessation therapy, representing savings in all situations. Aspirin is the second most cost-effective (euro 2,263 to euro 16,949 per year of life saved) followed by antihypertensives. Statins are the least cost-effective (euro 73,971 to euro 190,276 per year of life saved). CONCLUSIONS: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.