Long-term follow up with heart bypass patients treated in Veterans Affairs hospitals shows that 85 percent of left internal mammary artery grafts and 61 percent of vein grafts remain open (patent) after 10 years, and that these grafts are more likely t
In the first epidemiological study designed and executed specifically to determine the heart-attack risk associated with COX-2 inhibitors rofecoxib (Vioxx) and celecoxib (Celebrex), researchers at the
In a study to determine the prevalence of a range of symptoms among older persons living independently with advanced chronic diseases, researchers at Yale have found that the majority experienced multiple moderate or severe symptoms. "The clini
Delayed enrollment in hospice can result in increased depression among family members after the death of their loved one, according to a study by Yale researchers published in the American Journal of Psy
A first-of-its-kind study of safety issues surrounding the medical use of cannabis has just been launched. Known as the COMPASS study (Cannabis for the management of pain: assessment of safety study), the research initiative will follow 1400 chronic pa
Does stress speed up the onset of skin cancer? The answer, in mice anyway, appears to be "yes." Scientists at the Johns Hopkins Kimmel Cancer Center say that chronic stress may speed
An international trial comparing blood-pressure lowering treatments has been stopped early due to the significantly better performance of one of the treatments in the trial.The 19,000 patient A
Young obese women who are otherwise healthy have hearts that exhibit changes in structure and function similar to those of hypertensive patients, which may help explain links between obesity and heart fail
Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies - BMJ Online First.Migraine sufferers are twice as likely to suffer a stroke than tho
For the first time scientists have demonstrated a model that may explain how alcohol stimulates tumor growth. Their study, published in the January 15, 2005 issue of CANC
Current guidelines generally recommend the initiation of statin therapy when the estimated 10-year risk of a non-fatal heart attack or coronary death is at least 15-20%.
The Heart Protection Study (HPS) has previously shown that lowering cholesterol concentrations with 40 mg of simvastatin daily produces substantial reductions not just in the rates of such coronary events, but also in the rates of strokes and revascularisation procedures among a wide-range of high-risk individuals, irrespective of their pre-treatment blood cholesterol concentrations.
In the HPS, over 20 500 adults aged 40-80 years with vascular disease or diabetes were randomly assigned to 40 mg of simvastatin daily or a placebo. In the latest study the HPS researchers compared the costs of hospitalisations and statin therapy between the two groups, and estimated the cost-effectiveness for participants with varying levels of vascular disease risk.
They found a 22% relative reduction in the costs of hospitalisations for vascular events in the statin group, with similar proportional reductions in every sub-category of patients studied. Overall, the cost of avoiding a major vascular event was estimated to be £11 600, but there was substantial variation between the risk subgroups. For example, among individuals with a 42% 5-year risk of a major vascular event, the estimated cost-effectiveness was £4 500 per major vascular event avoided. By contrast, among those with a 12% 5-year risk, it was estimated to be £31 100. The authors believe that initiation of statin therapy should now be considered for people at lower risk for coronary or other major vascular events than is currently recommended.
Professor Rory Collins (Clinical Trial Service Unit, University of Oxford, UK), principal investigator of HPS, concludes: "As simvastatin and other statins come to the end of their patent life, the fall in the drug cost should produce a corresponding improvement in the costeffectiveness of treatment. In the UK, the patent expired in May 2003, and the price of generic simvastatin has already fallen to about 15% of the 2001 proprietary price; as has also occurred elsewhere. At this price, the cost savings from reduced hospitalisations during the treatment period would outweigh the cost of 40 mg simvastatin daily for people with a 5-year major vascular event risk down to at least 12% - or, approximately equivalently, major coronary event risk of at least 4%. It now seems appropriate to consider reducing the estimated level of risk for major vascular events at which initiation of statin therapy is recommended."
In an accompanying comment Kumiko Imai (US Centers for Disease Control and Prevention, USA) states: "Whilst the HPS study has shown that statin therapy decreases use of hospital resources, it is not clear how the therapy affects total use of health-care resources . . . Conducting economic evaluations alongside clinical trials is a viable means to evaluate health interventions. However, if such studies are to contribute to policy debates, it is important to generate information in a way that allows us to do what economic evaluations do best - to inform decision-making about resource allocation that maximises population health."
http://www.thelancet.com