GAO: Few strategies to prevent heart disease provide cost savings

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The U.S. Government Accountability Office (GAO) ruled that a number of treatments to prevent cardiovascular disease were either not cost effective or offered no cost savings in a report released Aug. 11.

The GAO conducted a literature review that assessed 29 meta-analyses or comparative studies published in peer-reviewed journals between January 2007 and April 2014. The 29 studies focused on the cost-effectiveness or cost-savings impact of preventive services that included clinical interventions, drug treatments, lifestyle interventions, screenings and vaccinations.

The Senate Finance and Health, Education, Labor and Pensions committees requested the report as an update on a 2012 GAO review.

The only cost-effective clinical interventions addressed control of diabetes risk factors or diabetes-related foot care. GAO gave implantable defibrillators a thumbs down for cost savings if they are used to prevent sudden cardiac arrest in patients with congestive heart failure because of an MI but who have no symptoms at rest. The report also found no cost benefit in angioplasty and stenting for peripheral artery disease.

Under drug treatments, it found cost savings with the use of aspirin to prevent MIs in middle-age men with a 10-year risk for coronary heart disease, which aligns with U.S. Preventive Services Task Force recommendations. But aspirin to prevent stroke, future MIs and as an alternative to warfarin in people who have a low stroke risk showed not cost savings.  

Neither beta-blockers nor cholesterol-lowering drugs to prevent future MIs in patients with known coronary heart disease were considered cost effective. The use of cholesterol-lowering drugs failed to make the grade for cost-effectiveness when used to prevent MIs in patients with moderate to severe high cholesterol levels and a 10-year risk of coronary heart disease of more than 5 percent; and as primary prevention in patients with type 2 diabetes and high cholesterol but no history of cardiovascular disease.

Anticoagulants for pulmonary thrombosis showed cost savings in recently diagnosed patients but not for stroke prevention in several patient populations. Few lifestyle intervention or screening approaches were cost effective in the report, and none of those that offered a cost benefit targeted cardiovascular disease.

The report made no recommendations and the Senate is not expected to comment on the findings.