Decision-making using absolute cardiovascular risk reduction and incremental cost-effectiveness ratios: a case study

BACKGROUND Many clinical guidelines have adopted a multifactorial cardiovascular risk assessment to identify high-risk individuals for treatment. The Framingham risk chart is a widely used risk engine to calculate the absolute cardiovascular risk of an individual. Cost-effective analyses are typically used to evaluate therapeutic strategies, but it is more problematic for a clinician when faced with alternative therapeutic strategies to calculate cost effectiveness. AIM We used a single simulated-patient model to explore the effect of different drug treatments on the calculated absolute cardiovascular risk. METHODS The Framingham risk score was calculated on a hypothetical patient, and drug treatment was initiated. After every drug introduced, the score was recalculated. Single-exit pricing of the various drugs in South Africa was used to calculate the cost of reducing predicted cardiovascular risk. RESULTS The cost-effective ratio of an antihypertensive treatment strategy was calculated to be R21.35 per percentage of risk reduction. That of a statin treatment strategy was R22.93 per percentage of risk reduction. U sing a high-dose statin, the cost-effective ratio was R12.81 per percentage of risk reduction. Combining the antihypertensive and statin strategy demonstrated a cost-effective ratio of R23.84 per percentage of risk reduction. A combination of several drugs enabled the hypothetical patient to reduce the risk to 14% at a cost-effective ratio of R17.18 per percentage of risk reduction. CONCLUSION This model demonstrates a method to compare different therapeutic strategies to reduce cardiovascular risk with their cost-effective ratios.