Louis Coupal

The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease.

BACKGROUND Although exercise training improves cardiovascular disease (CVD) risk factors, few studies have evaluated its potential long-term cost-effectiveness. METHODS Using the Cardiovascular Disease Life Expectancy Model, a validated disease simulation model, we calculated the life expectancy of average 35- to 74-year-old Canadians found in the 1992 Canadian Heart Health Survey. The impacts of exercise training on cardiovascular risk factors were estimated as a 4% decrease in low-density lipoprotein (LDL) cholesterol, a 5% increase in high-density lipoprotein (HDL) cholesterol, and a 6 mm Hg decrease in both systolic and diastolic blood pressure. Exercise adherence was estimated at 50% for the first year and 30% for all additional years. Costs for a supervised exercise program determined from Canadian sources and converted to US dollars were estimated at

Cost-Effectiveness of Treating Hyperlipidemia in the Presence of Diabetes Who Should Be Treated?

605 for the first year (medical evaluation, stress test, exercise prescription, and program costs) and

Seizure vs. syncope: measuring serum creatine kinase in the emergency department.

367 for all additional years (program costs). For an unsupervised program, the costs were estimated at

Treating Osteoarthritis With Cyclooxygenase-2-Specific Inhibitors What Are the Benefits of Avoiding Blood Pressure Destabilization?

311 for the first year and

:Delayed Diagnosis of Gynecologic Tumors in Elderly Women: Relation to National Medical Practice Patterns

73 for all additional years. RESULTS The cost-effectiveness (CE) of an unsupervised exercise program (1996 U.S. dollars) was less than

Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study

12,000 per year of life saved (YOLS) for all individuals. The CE of a supervised exercise program was less than

Preventing cardiovascular disease among Canadians: What are the potential benefits of treating hypertension or dyslipidemia?

15,000/YOLS for men with CVD, and between

Estimating the benefits of patient and physician adherence to cardiovascular prevention guidelines: the MyHealthCheckup Survey.

12,000 and

Preventing cardiovascular disease among Canadians: Is the treatment of hypertension or dyslipidemia cost-effective?

43,000 for women with CVD and men without CVD. CONCLUSIONS Given the relatively few risks, substantial long-term benefits, and modest costs, an unsupervised exercise training program represents good value for all. A more expensive supervised exercise program is also cost-effective for most individuals with CVD.

Splenic enlargement and Traube's space: How useful is percussion?

BACKGROUND The objective of this study was to estimate the long-term costs and benefits of treating hyperlipidemia among diabetic patients with and without known cardiovascular disease after validating the Cardiovascular Life Expectancy Model. METHODS AND RESULTS The model estimates were compared with the Scandinavian Simvastatin Survival Study (4S) and used to estimate the long-term costs and benefits of treatment with simvastatin. Simulations were performed for men and women, 40 to 70 years of age, having pretreatment LDL cholesterol values of 5.46, 4.34, and 3.85 mmol/L (211, 168, and 149 mg/dL). We forecasted the long-term risk of cardiovascular events, the need for medical and surgical interventions, and the associated costs in 1996 US dollars. The model validated well against the observed results of the of the 4S diabetic patients. In this validation, the model estimates fell within the 95% confidence interval of the observed results for 7 of the 8 available end points (coronary deaths, total deaths, and so forth). Treatment with simvastatin for patients with cardiovascular disease is cost-effective for men and women, with or without diabetes. Among diabetic individuals without cardiovascular disease, the benefits of primary prevention were also substantial and the cost-effectiveness ratios attractive across a wide range of assumptions ( approximately