Objectives: The aim of this study was to evaluate the cost-effectiveness of four
risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins)
in primary prevention of cardiovascular disease.
Methods: Using data from the Framingham Heart Study and the Framingham Offspring
study, we built life tables to model the benefits of the selected interventions. Participants
were classified by age and level of risk of coronary heart disease. The effects of risk
reduction are obtained as numbers of death averted and life-years saved within a 10-year
period. Estimates of risk reduction by the interventions were obtained from meta-analyses
and costs from Dutch sources.
Results: The most cost-effective is smoking cessation therapy, representing savings in all
situations. Aspirin is the second most cost-effective (€2,263 to €16,949 per year of life
saved) followed by antihypertensives. Statins are the least cost-effective (€73,971 to
€190,276 per year of life saved).
Conclusions: A cost-effective strategy should offer smoking cessation for smokers and
aspirin for moderate and high levels of risk among men 45 years of age and older. Statin
therapy is the most expensive option in primary prevention at levels of 10-year coronary
heart disease risk below 30 percent and should not constitute the first choice of treatment
in these populations.
Keywords: Primary prevention, Cardiovascular disease, Cost-effectiveness analysis