QJM Advance Access originally published online on April 21, 2007
QJM 2007 100(5):277-289; doi:10.1093/qjmed/hcm020
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Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000–2010
1From the Division of Public Health, University of Liverpool, 2Department of Public Health, Dokuz Eylul University School of Medicine, 35340 Izmir, Turkey, 3International Health Research Group, Liverpool School of Tropical Medicine, Liverpool, UK
Address correspondence to Professor S. Capewell, Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB. email: capewell{at}liverpool.ac.uk
Received 26 June 2006 and in revised form 15 October 2006
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Abstract |
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Background: Coronary heart disease (CHD) in the UK affects 
3 million people, with >100 000 deaths annually. Mortality rates have halved since the 1980s, but annual NHS treatment costs for CHD exceed £2 billion.
Aim: To examine the cost-effectiveness of specific CHD treatments in England and Wales.
Methods: The IMPACT CHD model was used to calculate the number of life-years gained (LYG) from specific cardiological interventions from 2000 to 2010. Cost-effectiveness ratios (costs per LYG) were generated for each specific intervention, stratified by age and sex. The robustness of the results was tested using sensitivity analyses.
Results: In 2000, medical and surgical treatments together prevented or postponed approximately 25 888 deaths in CHD patients aged 25–84 years, thus generating 194 929 extra life-years between 2000 and 2010 (range 143 131–260 167). Aspirin and beta-blockers for secondary prevention following myocardial infarction or revascularisation, for angina and heart failure were highly cost-effective (<£1000 per LYG). Other secondary prevention therapies, including cardiac rehabilitation, ACE inhibitors and statins, were reasonably cost-effective (£1957, £3398 and £4246 per LYG, respectively), as were CABG surgery (£3239–£4601 per LYG) and angioplasty (£3845–£5889 per LYG). Primary angioplasty for myocardial infarction was intermediate (£6054–£12 057 per LYG, according to age), and statins in primary prevention were much less cost-effective (£27 828 per LYG, reaching £69 373 per LYG in men aged 35–44). Results were relatively consistent across a wide range of sensitivity analyses.
Discussion: The cost-effectiveness ratios for standard CHD treatments varied by over 100-fold. Large amounts of NHS funding are being spent on relatively less cost-effective interventions, such as statins for primary prevention, angioplasty and CABG surgery. This merits debate.
*Dr Fidan was employed at the National Institute for Clinical Excellence (London, UK) and London School of Hygiene and Tropical Medicine when this work was completed, but is currently employed as a Senior Health Economist by sanofi-aventis.
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  S Capewell and M O'Flaherty Maximising secondary prevention therapies in patients with coronary heart disease Heart, January 1, 2008; 94(1): 8 - 9. [Full Text] [PDF]
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