Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000-2010

摘要

Background: Coronary heart disease (CHD) in the UK affects ～3 million people, with > 100000 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 25888 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 (£27828 per LYG, reaching £69373 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.