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Anticoagulants (Medicine) --- Atrial fibrillation. --- Cost effectiveness.

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Background Cardiovascular disease (CVD) has for decades been the most common cause of death in Norway and most other Western countries. Several groups of drugs have shown in clinical trials to prevent CVD. In this report, we have evaluated the cost-effectiveness of these drugs. Methods Based on a model of the progression of CVD from healthy to death, we explored which drugs that might be cost-effective. Analyses were conducted both compared to no treatment and between different drugs. Analyses were conducted on different risk levels and in different age groups for both men and women. We also performed probabilistic sensitivity analyses. Our analyses were accompanied by a systematic review of other economic evaluations of preventive strategies against CVD. Results Calcium channel blockers, thiazides, beta blockers, aspirin and statins were all cost-effective compared to no treatment for all groups of men and women in age groups between 40 and 69. The life year gains for each of the drugs varied between 3 and 17 months. Calcium channel blockers and thiazides were the most cost-effective combination of two antihypertensive drugs. In the base case analyses, the combination of calcium channel blockers, thiazides and ACE-inhibitors was the most cost-effective combination of three drugs. The sensitivity analyses indicate considerable uncertainty related to the question of which was the most cost-effective of the antihypertensive drugs. Whether treatment was cost-effective compared to no treatment was concerned with less uncertainty. Our systematic review of other economic evaluations showed considerable discrepancies between analyses of prevention strategies against CVD. Discussion The results of this study indicate that statins, several antihypertensives and aspirin are cost-effective in all analysed groups between 40 and 69 years old. It is worthwhile noting, however, that the model is built on numerous assumptions, and this introduces considerable uncertainty with respect to optimal choice of therapies.

Cardiovascular diseases.

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Stroke is the third most common cause of death, a major cause of severe disability and accounts for considerable consumption of healthcare resources. Which medication should be chosen for the treatment of stroke depends on several factors, including efficiency and price. Task requirement The Norwegian Directorate of Health's development groups for the preparation of national clinical guideline for stroke have commissioned the Norwegian Knowledge Centre for the Health Services to conduct economic evaluations of some central recommendations in the stroke guideline. We evaluated the clinical efficacy and conducted health economic evaluation of: 1. Intravenous thrombolytic treatment of patients with acute stroke (within 3 hours and between 3 to 5 hours after symptom onset) in addition to standard treatment compared to treatment without thrombolysis 2. Pharmacological secondary prevention of stroke1. Antiplatelet therapy: acetylsalicylic acid (ASA) combined with slow-release dipyridamole compared with ASA monotherapy 2. Antiplatelet therapy: ASA combined with slow-release dipyridamole compared with clopidogrel monotherapy 3. Anticoagulation therapy with warfarin compared with ASA for prophylaxis of stroke in patients with atrial fibrillation Main Results1. Thrombolytic treatment within 3 hours after stoke reduces lifetime costs and adds quality-adjusted life years (QALYs) compared with standard treatment without thrombolysis for selected stroke patients. 2. Thrombolysis given between 3 and 5 hours after stroke is cost-effective compared to no thrombolytic treatment. However, the choice of thrombolysis in this time interval should also be carefully considered from an ethical perspective, because it leads to shorter life expectancy relative to no thrombolytic treatment. 3. The combination of ASA and extended-release dipyridamole increases QALYs and reduces lifetime costs compared with ASA monotherapy in secondary prevention of stroke. 4. The use of ASA combined with slow-release dipyridamole for patients of 70 years reduces lifetime costs and adds QALYs compared to clopidogrel for secondary prevention of stroke.5. Anticoagulation therapy with warfarin has lower expected costs and higher expected QALYs compared with ASA therapy for stroke patients with atrial fibrillation.

Cost effectiveness. --- Thrombolytic therapy.

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Cost effectiveness. --- Young adults. --- Papillomaviruses. --- Vaccination.

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Background Smoking is an important risk factor for several diseases, including different cancers, lung diseases and cardiovascular diseases. About 21% of the Norwegian population are daily smokers. Interventions for smoking cessation are normally divided into counselling and drug treatment support. In Norway, two prescription drugs are available for use in smoking cessation; varenicline (Champix (r) or Chantix (r)) and bupropion (Zyban (r)). In addition, several options for nicotine replacement therapy are available, such as nicotine-gum, patches and lozenges. Commission We were commissioned to evaluate the cost-effectiveness of drugs for smoking cessation in a Norwegian setting. The economic evaluation will inform the revised treatment guideline for smoking cessation in primary care. Main findings1. Compared to no treatment, nicotine replacement therapy, bupropion and varenicline can all be considered cost-effective.2. When the drugs are evaluated relative to each other, varenicline is the most cost-effective alternative.

Smoking cessation. --- Cost effectiveness.