| 2. |
- Kahan, T, et al.
(författare)
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The effects of cardiac events on quality of life and indirect costs
- 2001
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Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 15:1, s. S91-S93
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Tidskriftsartikel (refereegranskat)abstract
- The ASCOT trial is designed to provide important information for treatment of patients with hypertension and hypercholesterolaemia. The economic consequences of alternative therapies, as studied in ASCOT, may be significant, and information about these consequences is important for development of treatment guidelines and for prescription decisions. Therefore a cost-effectiveness analysis based on data from ASCOT is planned. The rationale for and design of this study is described in another paper in this volume.1 This sub-study provides information for an extension of this cost-effectiveness study to include indirect costs and to adjust life years gained for quality of life (utility). Thus cost-effectiveness can be calculated both with and without indirect costs and both as cost per life year gained and cost per quality-adjusted life year (QALY) gained.2 This makes it possible to compare the results with similar studies of the cost-effectiveness of treatment of hypertension and hypercholesterolaemia.
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| 4. |
- Sever, P. S., et al.
(författare)
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Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial
- 2004
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Ingår i: Drugs. - 0012-6667. ; 64 Suppl 2, s. 43-60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed dyslipidaemic. METHODS: Of 19 342 hypertensive patients (aged 40-79 years with at least three other cardiovascular risk factors) randomised to one of two antihypertensive regimens in the Anglo-Scandinavian Cardiac Outcomes Trial, 10,305 with nonfasting total cholesterol concentrations 6.5 mmol/L or less were randomly assigned additional atorvastatin 10 mg or placebo. These patients formed the lipid-lowering arm of the study. We planned follow-up for an average of 5 years, the primary endpoint being non-fatal myocardial infarction and fatal CHD. Data were analysed by intention to treat. FINDINGS: Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50-0.83], p = 0.0005). This benefit emerged in the first year of follow-up. There was no significant heterogeneity among prespecified subgroups. Fatal and non-fatal stroke (89 atorvastatin vs 121 placebo, 0.73 [0.56-0.96], p = 0.024), total cardiovascular events (389 vs 486, 0.79 [0.69-0.90], p = 0.0005), and total coronary events (178 vs 247, 0.71 [0.59-0.86], p = 0.0005) were also significantly lowered. There were 185 deaths in the atorvastatin group and 212 in the placebo group (0.87 [0.71-1.06], p = 0.16). Atorvastatin lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months, and by 1.1 mmol/L after 3 years of follow-up. INTERPRETATION: The reductions in major cardiovascular events with atorvastatin are large, given the short follow-up time. These findings may have implications for future lipid-lowering guidelines.
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