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Current 10-year atherosclerotic cardiovascular disease risk threshold for statin eligibility is cost-effective for primary prevention
Commentary on: Pandya A, Sy S, Cho S, et al. Cost effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA 2015;314: 142–50 . Context The American College of Cardiology American Heart Association (ACC/AHA) cholesterol guidelines replaced the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) in 2013,1 a change that was accompanied by significant controversy.2 Notable among the criticisms was that the pooled cohort equations (PCE) overestimates risk and coupled with the relatively lenient risk threshold (10-year PCE &g...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Yeboah, J. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Neuromuscular disease, Stroke, Ischaemic heart disease, Musculoskeletal syndromes, Health economics, Health service research Economic analysis Source Type: research

Ezetimibe provides incremental reduction in risk for cardiovascular events and need for revascularisation following an acute coronary syndrome
Commentary on: Cannon CP, Blazing MA, Giugliano RP, et al., IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015;372:2387–97. Context Use of statin therapy to treat dyslipidemia in patients with established coronary artery disease is the standard of care worldwide. Given the negative results of a number of trials that tested the use of adjuvant lipid-lowering therapies against a statin background, there has been great scepticism about whether or not non-statin drugs provide incremental benefit.1–3 Ezetimibe inhibits the absorption of both dietary and bili...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Toth, P. P. Tags: Health policy, Epidemiologic studies, Genetics, Immunology (including allergy), Vaccination / immunisation, Stroke, Diet, Ischaemic heart disease, Health economics, Health service research, Lipid disorders Therapeutics/Prevention Source Type: research

Potential cost-savings may be considerable with management of hypertension according to updated US hypertension guidelines, but for women aged 35-44 years these benefits are unlikely
Commentary on: Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med 2015;372:447–55. Context The number of people with hypertension is anticipated to increase despite greater awareness of the condition as a risk factor for cardiovascular disease (CVD) and more options for treatment. Clinical guidelines are evidence-based recommendations used to inform clinician practice when treating an individual patient. Regular updates of guidelines are important to ensure their ongoing relevance. Moran and colleagues investigated the potential cost impli...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Cadilhac, D. A., Kim, J. Tags: Health policy, Drugs: cardiovascular system, Stroke, Hypertension, Health economics, Health service research, Guidelines Economic analysis Source Type: research

Bypass surgery is more cost-effective than percutaneous coronary interventions for most patients with multivessel or left main coronary artery disease
Commentary on: Cohen DJ, Osnabrugge RL, Magnuson EA, et al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2014;130:1146–57. Context The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) trial compared outcomes of percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary a...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Agarwal, S., Kapadia, S. R. Tags: Health policy, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Health economics, Health service research Economic analysis Source Type: research

Lung cancer CT screening is cost-effective but implementation matters
Commentary on: Black WC, Gareen IF, Soneji SS, et al.; National Lung Screening Trial Research Team. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 2014;37:1793–802. Context The National Lung Screening Trial (NLST) revealed a 20% reduction in lung cancer mortality from three annual low-dose CT screening scans compared with chest radiographs in high-risk individuals.1 Since up to 10 million individuals in the USA may qualify for annual CT screening, policymakers have legitimately questioned whether the benefits of lung cancer screening justify the potential high costs of large-sca...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Goulart, B. Tags: Smoking and tobacco, Health policy, Epidemiologic studies, Stroke, Screening (oncology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Health economics, Health service research, Health education, Screening (publi Source Type: research