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Asymptomatic peripheral arterial disease: is pharmacological prevention of cardiovascular risk cost-effective?
Karolinska Institute.
Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
Karlstad Hospital.
Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi.
2011 (engelsk)Inngår i: EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION and REHABILITATION, ISSN 1741-8267, Vol. 18, nr 2, s. 254-261Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Peripheral arterial disease (PAD) is associated with an increased risk of early death in cardiovascular (CV) disease. The majority of PAD subjects are asymptomatic with a prevalence of 11 per cent among the elderly. Long-term drug prevention aiming to minimize disease progression and CV events in these subjects is probably beneficial, but expensive. The purpose of this analysis was to evaluate the cost-effectiveness of pharmacological risk reduction in subclinical PAD. Long-term costs and quality-adjusted life years (QALYs) were estimated by employing a decision-analytic model for ACE-inhibitor, statin, aspirin and non-aspirin anti-platelet therapy. Rates of CV events without treatment were derived from epidemiological studies and event rate reduction were retrieved from clinical trials. Costs and health-related quality of life estimates were obtained from published sources. All four drugs reduced CV events. Using ACE-inhibition resulted in a heart rate (HR) of 0.67 (95% CI: 0.55-0.79), statins 0.74 (0.70-0.79), and clopidogrel 0.72 (0.43-1.00). Aspirin had a HR of 0.87 and the 95% CI passed included one (0.72-1.03). ACE-inhibition was associated with the largest reduction in events leading to the highest gain in QALYs (7.95). Furthermore, ACE-inhibitors were associated with the lowest mean cost (sic)40.556. In conclusion, while all drugs reduced CV events, ACE-inhibition was the most cost-effective. These results suggest that we should consider efforts to identify patients with asymptomatic PAD and, when identified, offer ACE-inhibition.

sted, utgiver, år, opplag, sider
Lippincott Williams and Wilkins , 2011. Vol. 18, nr 2, s. 254-261
Emneord [en]
Cost-benefit analysis, peripheral vascular disease, pharmacological prevention
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-68224DOI: 10.1177/1741826710389368ISI: 000289895800016OAI: oai:DiVA.org:liu-68224DiVA, id: diva2:416860
Tilgjengelig fra: 2011-05-13 Laget: 2011-05-13 Sist oppdatert: 2012-03-15

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