Abstract

Prevention of cardiovascular disease (CVD) can be advanced with drug treatment of modifiable risk factors, but at what expense to the Canadian healthcare budget? This study assessed the costeffectiveness of drug treatments for two modifiable risk factors of CVD - dyslipidemia and hypertension. Drug treatment for dyslipidemia and hypertension appears economically attractive overall, but less so for younger age groups. Background: Lipid and hypertension therapies have been proven as effective in the prevention of cardiovascular disease (CVD). However, with adherence to current Canadian guidelines for these therapies, the costs of drug treatment are expected to escalate. The authors sought to compare drug costs and benefits of extending treatment to all Canadians free of CVD and diabetes for dyslipidemia and hypertension.

Methods: A cost-effectiveness analysis was conducted from the perspective of the Canadian healthcare system. The study population was Canadian male and female free of CVD and diabetes, between ages 40 and 74. Estimates of costs and benefits, in terms of years of life saved (YOLS), were derived from published clinical trials, national surveys of drug use and risk factors, and Canadian treatment guidelines. Cost-effectiveness over $50,000 is the threshold. The Markov model was used to estimate life expectancy of patients with cardiovascular disease.

Findings: For lipid therapy, the average cost-effectiveness ratio for all ages is $16,700 per YOLS. The most costly group to treat is women ages 40 to 49 ($43,000 per YOLS). As 2.33 million Canadians would be eligible for dyslipidemia treatment, the estimated total cost for the healthcare system would be $18.3 billion, while saving 1.1 million person-years of life, due to prevention or delay of CVD.

For hypertensive therapy, the average cost-effectiveness ratio for all ages is $37,100 per YOLS. Costeffectiveness ratios were higher for the younger age group (40-49) reaching $63,900 for men and $70,500 for women. Since the number of Canadians who eligible for treatment is 2.34 million, the healthcare system would be required to pay $17.5 billion to save 472,100 person-years of life, due to prevention or delay of CVD.

Conclusions: This study estimated the cost-effectiveness of primary prevention of CVD with treatment of dyslipidemia and hypertension. The authors concluded that treating dyslipidemia or hypertension to prevent CVD is economically attractive among most Canadians, but less so for the younger age group. While the cost of treatment would be substantial, significant reductions in morbidity and mortality would be observed after years of treatment. Policy makers and funders of drug benefit programs may use these cost-effectiveness results in formulary approval deliberations.

References

Grover, S. & Coupal, L. (2008). Preventing cardiovascular disease among Canadians: Is the treatment of hypertension or dyslipidemia cost-effective? Canadian Journal of Cardiology, 24(12): 891-898.