Plenary speakers in the spotlight: Bengt Jönsson, John Kastelein

Professor Bengt Jönsson

ECONOMIC ISSUES IN CARDIOVASCULAR DISEASE: WHAT ARE THE COSTS OF PREVENTION?

Bengt Jönsson is Professor in Health Economics, Stockholm School of Economics, and Director of the Center for Health Economics. He is currently a member of the board for the Karolinska University Hospital, Stockholm, Sweden. Professor Jönsson has been a temporary adviser on many issues to the World Health Organization and a consultant to the Organisation for Economic Co-operation and Development (OECD), the World Bank and the United Nations Industrial Development Organization (UNIDO).

Despite advances in management, cardiovascular disease (CVD) remains a public health challenge. In the European Union, CVD is estimated to cost the economy €192 billion each year, accounting for about 10% of total health care expenditure. However, this does not take account of important indirect costs, due to loss of productivity and the need for informal care.

Statins remain the cornerstone of dyslipidaemia treatment for prevention of CVD. Economic evaluations based on clinical outcomes trials have shown that improved care associated with statin therapy came at a reasonable price in most risk groups. As statins come off patent, their use is associated with even greater cost savings. This poses a challenge for demonstrating the cost-effectiveness of new therapies entering the field.

Recent guidelines have redirected their focus to take account of the fundamental importance of lifestyle intervention, largely in response to the obesity/diabetes pandemic. Economic evaluations of the value of such interventions have shown that these have the potential to be highly cost-effective, and suggest that increased resources should be directed to primary care to implement such changes. However, such findings also raise a number of issues, including who will provide the necessary investment to fund programs for lifestyle intervention, and what incentives for participation should be offered to motivate those most likely to benefit.

Such issues warrant urgent evaluation given the increasing need for financial restraint in healthcare systems within Europe and beyond.

Key references

1. Jönsson B. A 3-year lifestyle intervention for adults at moderate to high risk of cardiovascular disease is cost effective when added to standard care and improves physical health-related quality of life. Evid Based Med 2011;16:70-1.

2. Lindgren P, Jönsson B. Cost-effectiveness of statins revisited: lessons learned about the value of innovation. Eur J Health Econ 2011 Apr 29. [Epub ahead of print].

3. Lindgren P, Jönsson B. From 4S to IDEAL: the health economics of the statin trials. Eur J Cardiovasc Prev Rehabil 2009;16:138-43.