[Cost-effectiveness of prevention: opportunities for public health policy in the Netherlands].
ABSTRACT To gain insight into the cost-effectiveness of new preventive interventions.
Systematic review and interviews.
Based on literature search, a search of the project database of ZonMw and interviews with experts, the National Institute for Public Health and the Environment drew up a long list of preventive interventions that are potentially cost-effective but are not yet systematically carried out in the Netherlands. From this long list, 21 interventions were selected for each of which, at least 3 economic evaluations were available that indicate favourable cost-effectiveness (< Euro 20,000,--per QALY gained).
The majority of the interventions concerned vaccination and screening programmes (7 and 5 respectively). Only a small minority concerned health promotion or health protection (1 respectively 3). There was strong evidence that 5 interventions were both cost-effective, and feasible. These were: screening for Chlamydia, screening for diabetic retinopathy in type 2 diabetes, screening for neonatal group beta streptococcal infections through a combination strategy, prevention of recurrent myocardial infarction through heart habilitation, and prevention of head injuries by wearing of bicycle helmets by children.
Before implementation of preventive interventions, it is necessary to investigate whether these interventions are also cost-effective in the Dutch context.
Article: The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population.[show abstract] [hide abstract]
ABSTRACT: Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. Design A health economic modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care. Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events. Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose.BMJ open. 01/2011; 1(2):e000363.