Abstract 23084: Marked Global Variability in Cost Effectiveness of Lipid-Lowering and Combination Antihypertensive Therapies in Primary Prevention: Analyses of the HOPE-3 Trial
Bibliographic record
Abstract
Background: The Heart Outcomes Prevention Evaluation (HOPE) - 3 trial demonstrated that low dose lipid-lowering medication alone or with an angiotensin receptor blocker (ARB)+ thiazide resulted in a significantly lower risk of cardiovascular events compared to placebo in intermediate risk persons without cardiovascular disease. Since use of these medications in primary prevention could have significant cost implication, we report the cost analysis of the HOPE-3 trial. Methods: Hospitalization events, procedures, medications and study drugs were extracted for each patient. We applied country-specific costs to healthcare resources consumed for each patient. We calculated average cost per patient for the length of the study (median follow-up 5.6 years). Costs are reported in US dollars and discounted at 3% per year. The costs of the study drugs vary considerably between countries and we use the most locally affordable (generic) lipid-lowering medication and ARB + diuretic combination. Results: In most regions, use of lipid-lowering medication in combination with antihypertensive drugs in HOPE-3 was cost-neutral or cost-saving as the cost of these medications was offset by savings in other costs (events, procedures, and usual medications). Surprisingly, in India and China, the cost of these medications is the main component of overall health expenditures, being more expensive than all other costs. Conclusions: The use of lipid-lowering medication alone or with antihypertensives agents is cost-saving in most regions by providing significant clinical benefit to intermediate risk persons without cardiovascular disease. Prices for these generic drugs in India and particularly in China are high relative to other costs and policies to reduce the prices of these are needed to ensure that generics are more affordable. Primary prevention using lipid-lowering medication and antihypertensive agents would be cost-neutral or cost-saving worldwide.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.011 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".