Table 33.5Cost-Effectiveness Analyses for CVD Interventions in High-Income Countries

InterventionAlternativeCost-effectivenessSource
IHD
Lovastatin, 20 mg/dayDietCost saving (males age 45–54); US$4,700/life year saved (females age 45–54)Goldman and others 1991a
Defibrillators in emergency vehiclesNo defibrillatorsUS$47 to US$551/life year saved; up to US$2,600 in rural areasJermyn 2000; Ornato and others 1988; Rowley, Garner, and Hampton 1990b
Propranolol for postmyocardial infarction (beta-blocker)No beta-blockersUS$2,400 for high-risk patients; US$23,400 for low-risk patientsGoldman and others 1988 a
CABG for left main diseaseMedical managementUS$2,700 to US$6,700/life year savedWeinstein and Stason 1982;b A. Williams 1985a
PTCA (men age 55 with severe angina)Medical managementUS$6,400 to US$8,800/life year saved (US$28,000 to US$132,000 for mild angina)Wong and others 1990b
Primary angioplastyNo intervention after AMIUS$12,000/quality-adjusted life yearParmley 1999
Three-vessel CABGMedical managementUS$14,000/life year savedWeinstein and Stason 1982
Streptokinase (reperfusion), with PTCA availableNo intervention after AMIUS$15,000/quality-adjusted life yearParmley 1999
Tissue plasminogen activator (AMI)SteptokinaseUS$33,500/life year savedLorenzoni and others 1998
Primary stenting, one-vessel, men over age 55PTCAUS$32,000/life year savedCohen and others 1993
Three-vessel CABG for severe anginaPTCAUS$41,000/life year savedWong and others 1990b
Two-vessel CABGMedical managementUS$33,000 to US$90,000/life year savedWeinstein and Stason 1982; A. Williams 1985
Angiography for coronary artery diseaseCABGUS$45,000/quality-adjusted life yearDoubilet, McNeil, and Weinstein 1985a
Stroke
Anticoagulants (warfarin) for chronic nonvascular atrial fibrillationAspirinWarfarin dominates for high-risk patients; US$10,000/quality-adjusted life year for medium-risk patients; US$462,000/quality-adjusted life year for low-risk patientsGage, Cardinalli, and Owens 1998c
Anticoagulants for mitral stenosis and atrial fibrillationNo anticoagulantsUS$5,500/quality-adjusted life yearEckman, Levine, and Pauker 1992c
Carotid endarterectomy(symptomatic patients)AspirinUS$5,100 to US$51,000/life year savedKuntz and Kent 1996; Matchar, Pauk, and
Cardiac transplantNo transplantUS$54,000/life year savedEvans 1986a
Arrhythmias
Implantable cardioverter-defibrillator for cardiac arrest (long term)Medical managementUS$28,000/life year savedKing, Aubert, and Herman 1998; Kuppermann and others 1990
RHD
Benzathine penicillin injectionsNo injectionsCost savingStrasser 1985

Source: Authors.

Note: All costs have been converted to 2001 U.S. dollars.

b. Surveyed in Tengs and others 1995.

c. Surveyed in Holloway and others 1999.

From: Chapter 33, Cardiovascular Disease

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.