This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Drug and dietary treatment of hypercholesterolemia, hypertension treatment, and smoking cessation treatment in the prevention of cardiovascular disease.

Treatment; primary prevention.

Cost-effectiveness analysis.

Patients with cardiovascular risk factors.

Hospital. The economic study was carried out in Barcelona, Spain.

The effectiveness data related to the drug treatment of hypercholesterolemia were extracted from papers published between 1990 and 1995. The effectiveness data related to the dietary treatment of hypercholesterolemia were derived from studies published in 1991 and 1997. The effectiveness data related to hypertension treatment were gathered from studies published in 1987,1990, and 1993. The effectiveness data related to the smoking cessation treatment were collected from studies published in 1986, 1989, and 1994. The resource utilisation data were extracted from studies published between 1991 and 1992. 1996 prices were used.

The evidence for the final outcomes was derived from a review of previously published studies and was estimated using the Framingham equation.

The multiple logistic Framingham equation was used to estimate the life-years gained.

The outcomes assessed in the review were the rate of cholesterol reduction due to the hypercholesterolemia treatment with lovastatin (20, 24 and 80 mg/day), cholestyramine (12 and 24 g/day), and gemfibrozil (1.2 g/day) or dietary treatment; diastolic blood pressure reduction; smoking cessation rate and adherence to the smoking cessation programme.

Not stated.

Not stated.

Not stated.

Narrative method.

At least 11 published papers were used to extract the clinical probabilities.

Not stated.

Not stated.

The rate of cholesterol reduction due to the hypercholesterolemia treatment with lovastatin (20, 24 and 80 mg/day) was 20, 28, and 34%, respectively; with cholestyramine (12 and 24 g/day) it was 10 and 13%, respectively; and with gemfibrozil (1.2 g/day) it was 11%. The rate of cholesterol reduction due to the dietary treatment was 5%. The range of diastolic blood pressure reduction for patients with moderate/severe hypertension was from 4.9 mm Hg for captopril to 10 mm Hg for nifedipine. The corresponding values for patients with mild hypertension had a range from 13.4 mm Hg for hydrochlorothiazide to 21.4 mm Hg for propranolol. The smoking cessation rate for medical advice was 3.8% versus 6.7 and 8.1% for nicotine gum and nicotine patches, respectively. Adherence to the smoking cessation programme for medical advice was 35% versus 25% for the programme using medical advice and nicotine treatment.

Life years gained (LYG) were estimated as the main measure of benefit using the Framingham equation.

Costs were discounted. Quantities were not reported separately from the costs. Unit of cost was reported separately for the cost items. The direct treatment cost consisted of the cost of medication, medical visits, blood analysis, and screening for hypercholesterolemia and hypertension. Total programme cost minus cost saving from cardiovascular disease averted through prevention led to the net programme cost. It was not explicitly stated from whose perspective the cost analysis was performed. The sources of cost data were reports published in 1992.1996 price data were used.

Not considered.

US dollars ($).

Not carried out.

The results for estimated life years gained (LYG) were not reported.

The discount rate adopted was 5%. The results of cost analysis were not reported consistently. The medical advice in smoking cessation programme had an average (per smoker) programme cost of $147.30 versus $348 for nicotine gum and$467.3 for nicotine patches.

Average and incremental cost-effectiveness ratios were reported in terms of gender, age categories, and type of drug used. The hypercholesterolemia treatment programme had a range of average cost-effectiveness from $33,850 to $105,300 per LYG for men and from $104,100 to $350,000 for women. In terms of drug treatment for hypercholesterolemia, lovastatin had the lowest incremental cost-effectiveness ratio. The moderate/severe hypertension treatment programme had a range of average cost-effectiveness from $7,061 per LYG to $44,678 for men and from $6,351 to $81,027 for women. The corresponding figures for mild hypertension were from $10,877 per LYG to $68,246 for men and from $10,100 to $126,990 for women. According to the incremental cost-effectiveness ratio, hydrochlorothiazide was the most cost-effective drug for the hypertension treatment. The smoking cessation programme had a range of cost-effectiveness ratios from $2,608 to $5,494 per LYG for men versus $4,413 to $8,058 for women. The dietary treatment programme had a range of cost-effectiveness ratios from $7,581 to $38,442 per LYG for men versus from $31,806 to $149,246 for women.

Cost-effectiveness analysis carried out in this study show that lovastatin, hydrochlorothiazide, propranolol, and nifedipine for individual treatment/prevention of cardiovascular disease should be considered efficient and resources should be provided for their implementation.

No specific prevention programme was considered as the comparator.

Since no systematic literature review or quality assessment of the primary studies was performed, there is insufficient information with which to judge the internal validity of the estimate of the benefit measure.

Quantities were not reported separately from the costs. The internal validity of cost estimation can not be assessed since adequate information was not given in regard to the reliability of the cost data.

Given the lack of a systematic literature review, quality assessment of the primary studies, and statistical analysis of the costs, the results need to be treated with some caution. As acknowledged by the author, costs and benefits estimated in this study may not be generalisable to other settings/countries.

None stated

This study also appears in Pharmacoeconomics 1998;13(5 Part 2):623-643 for which an abstract is also included in this database (988153).