Cardiovascular disease prevention with a multidrug regimen

(Referred by Marcelo Gustavo Colominas [mgcolominas@gigared.com])
Cardiovascular disease prevention with a multidrug regimen
in the developing world: a cost-eff ectiveness analysis
Thomas A Gaziano, Lionel H Opie, Milton C Weinstein
Summary
Background Cardiovascular disease is the leading cause of death, with 80% of cases occurring in developing countries.
We therefore aimed to establish whether use of evidence-based multidrug regimens for patients at high risk for cardiovascular disease would be cost-eff ective in low-income and middle-income countries.
Methods We used a Markov model to do a cost-eff ectiveness analysis with two combination regimens. For primary prevention, we used aspirin, a calcium-channel blocker, an angiotensin-converting-enzyme inhibitor, and a statin, and assessed them in four groups with diff erent thresholds of absolute risks for cardiovascular disease. For secondary prevention, we assessed the same combination of drugs in one group, but substituted a β blocker for the
calcium-channel blocker. To compare strategies, we report incremental cost-eff ectiveness ratios (ICER), in US$ per quality-adjusted life-year (QALY).
Findings We recorded that preventive strategies could result in a 2-year gain in life expectancy. Across six developing World Bank regions, primary prevention yielded ICERs of US$746–890/QALY gained for patients with a 10-year absolute risk of cardiovascular disease greater than 25%, and $1039–1221/QALY gained for those with an absolute risk greater than 5%. ICERs for secondary prevention ranged from $306/QALY to $388/QALY gained.
Interpretation Regimens of aspirin, two blood-pressure drugs, and a statin could halve the risk of death from cardiovascular disease in high-risk patients. This approach is cost-eff ective according to WHO recommendations, and is robust across several estimates of drug effi cacy and of treatment cost. Developing countries should encourage the use of these inexpensive drugs that are currently available for both primary and secondary prevention.