[indices] Lancet report of multidrug regimen to Prevent Cardiac Death in Low-Income Nations

["Janet McNeece" <jmcneece@mail.rah.sa.gov.au>]

Here is a report regarding a the use of a multidrug regimen to prevent
cardiac death, specifically looking at cost effectiveness in low-income
nations

Hope this is useful

Janet  

Reuters Health Information 2006. C 2006 Reuters Ltd. 
NEW YORK (Reuters Health) Aug 18 - 
Combination therapy with aspirin, two anti-hypertensive drugs and a statin
cuts the risk of death from cardiovascular disease (CVD) by about half and
is a cost-effective approach, even in developing countries, according to a
report in the August 19th issue of The Lancet.

In nearly all parts of the world, CVD is the leading cause of death, 80% of
which occur in developing countries, Dr. Thomas A. Gaziano and his team
point out. Effective treatments tend to be underused in poorer regions
because they are believed to be too expensive, but the availability of
generic drugs has brought their cost down to affordable levels.

Dr. Gaziano, from Harvard Medical School in Boston, and his associates used
Markov modeling to analyze the cost-effectiveness with two regimens. They
compared strategies in the six low- and middle-income regions defined by the
World Bank.

Quality-adjusted life years gained were obtained from the World Health
Organization's (WHO) Global Burden of Disease. Drug costs were obtained from the International Drug Price Indicator guide.

For primary prevention among individuals age 50 and older, the daily therapy included 81 mg aspirin, 40 mg of the statin drug lovastatin, 10 mg of the ACE inhibitor lisinopril, and 5 mg of the calcium channel blocker
amlodipine. For those who already had an MI, angina, or ischemic stroke, the regimen was the same, except that the beta-blocker metoprolol was
substituted for amlodipine

In the absence of treatment the lifetime risk of death from CVD at baseline
ranged from 22% to 44% among subjects 35 to 74 years old. The authors
estimate that using their most conservative estimates, and without aspirin,
the incremental cost-effectiveness ratios for primary prevention were $306 -$388 per quality-adjusted life-year gained.

The greatest reduction in risk -- 42% to 57% -- would occur with primary
prevention among individuals with 10-year absolute risk > 5%.

Among those requiring secondary prevention, mortality would be reduced by
10% to 15%. The incremental cost-effectiveness ratios for secondary
prevention was $306 - $388 per quality-adjusted life-year gained, compared
with no treatment in all six regions.

The WHO considers health interventions to be cost-effective if their
incremental cost-effectiveness ratios are less than three times the
country's gross national income per head. In the six regions, these figures
ranged from $1320 to $11,010.

Dr. Gaziano's team indicates that these ratios are below this threshold in
all the regions, which should "make these strategies acceptable in all the
developing regions of the world under this criterion."

Their approach is "robust across several estimates of drug efficacy and of
treatment cost," they write. Therefore, "developing countries should
encourage the use of these inexpensive drugs that are currently available
for both primary and secondary prevention."

Lancet 2006;368:679-686.

Janet McNeece
Senior Pharmacist
Medicines Information Department
Royal Adelaide Hospital
Adelaide 5000
Tel +61 (08) 82225546
Fax +61 (08) 82225891
Email jmcneece@mail.rah.sa.gov.au