Costs of providing a particular medical service can be measured, but it is more difficult to assess whether the service provides good value for the money spent. Rigorous trials have demonstrated the health benefits connected with interventions for treatment and prevention of
cardiovascular disease (CVD), and in-depth analyses of the costs associated with many of those interventions have been performed. Careful use of terminology clearly differentiating among cost-minimization (relative costs of proved equivalent
therapeutics), cost-effectiveness (lives saved or years of life added), and cost-benefit (total net effect in monetary terms) analyses is warranted. Although trials commonly assess clinical effectiveness as reductions in mortality or CVD-specific outcomes, improvement in quality of life may be equally important and is expressed in quality-adjusted life-years. Comparisons between
therapies can be assessed as a cost-effectiveness ratio. Extensive cost-effectiveness studies have been conducted on many important cardiovascular
therapies: (1) beta-blockers and
diuretics for multiple CVD outcomes, mortality, and prevention of recurrent
myocardial infarction (MI); (2)
statins for both primary and
secondary prevention of CVD; (3)
enalapril for prevention and treatment of
congestive heart failure; (4)
tissue plasminogen activator treatment of acute MI; (5)
coronary artery bypass graft for left main, single-, and 2-vessel
coronary artery disease, or severe angina; (6) physician counseling for smoking; and (7)
radiofrequency ablation therapy for
Wolff-Parkinson-White syndrome.
Therapies considered economically attractive include (1)
secondary prevention with
statins in
hyperlipidemia, (2) smoking cessation programs, (3) primary prevention in treatment of
high blood pressure with
diuretics and beta-blockers, (4) primary prevention with regular exercise programs, (5)
secondary prevention with
cardiac rehabilitation, and (6) postinfarction treatment with beta-blockers and
angiotensin-converting enzyme (
ACE) inhibitors. A recent cost-minimization analysis has been performed showing
aspirin to be a "best buy"
therapy for
secondary prevention of CVD. The Ongoing
Telmisartan Alone and in Combination with
Ramipril Global Endpoint Trial (ONTARGET) and
Telmisartan Randomized Assessment Study in ACE-I Intolerant Patients with
Cardiovascular Disease (TRANSCEND) program provide potential opportunities for both cost-minimization and cost-effectiveness analyses.