Clinical trials have shown that reductions in blood pressure and lipid levels can reduce cardiovascular morbidity and mortality. Primary prevention with pharmaceuticals, however, has not proved to be cost-effective except in patient groups at high risk. As patents expire and generic drugs are introduced, the prices drop. The objective of this study was to examine to what extent the price reductions make statins and antihypertensives cost-effective in primary prevention.

Methods

We developed a Markov model (the Norwegian Cardiovascular Disease model (NorCaD)) to simulate the development of cardiovascular disease from disease-free through angina pectoris, myocardial infarction, heart failure, and stroke to death. Data on the effectiveness of antihypertensives and lipid lowering drugs were captured from recent meta-analyses.

The Norwegian willingness-to-pay threshold of $66 000 per life year gained was applied.

We modelled uncertainty with distributions (gamma, beta, lognormal and normal) for all parameters (more than 200) to perform probabilistic sensitivity analyses.

Results

Both low dose thiazid (bendroflumethiazide 5 mg) and simvastatin 20 mg are cost-saving in most patient groups relevant for treatment (tables 2 and 3). Life-year gained with life-long thiazide treatment varies between 2 and 10 months, while for simvastatin the corresponding numbers are 5 and 22 months (undiscounted).

Explorative analyses indicate that thiazides and statins are cost-saving with 10-year risk of cardiovascular death greater than 1%.

Treatment with ACE-inhibitors was cost-effective compared to thiazides in the high risk groups among 40-year old men and women, but not in other groups aged 40, 50 and 60.

Compared to thiazides, calcium channel blockers (CCB) are cost-effective in all groups. .

Probabilistic sensitivity analyses indicate that the results are relatively robust with around 100% probability in all risk groups that interventions are cost-effective compared to no treatment.

Conclusions

Primary prevention of cardiovascular disease with simvastatin and various antihypertensives is cost-effective and even cost-saving with current drug prices. Ethical rather than cost concerns should influence the use of drugs in primary prevention of cardiovascular disease.