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Aims To estimate the cost-effectiveness of the current screening programme on Familial Hypercholesterolaemia (FH) in relatives of diagnosed FH-patients in The Netherlands.Methods and Results Data from 2229 screened FH-relatives, including age, sex, risk factor status and screening outcome, were combined with the Framingham risk function and national disease-specific cost data to arrive at a model-based comparison of survival and costs, with and without the screening programme. Cost-effectiveness ratios were computed for various treatment strategies, with no screening as reference. Costs per life year gained varied between 25·5- and 32-thousand Euros, depending upon the precise treatment strategy after a positive screen. The costs for screening (tracing the FH-positive individuals) were much lower than the follow-up costs (treatment), of which 80% were costs for statins. Consequently, the costs per life year gained of alternative screening programmes are about the same.Conclusion The cost-effectiveness ratio of FH screening is within the range requiring explicit political consideration in The Netherlands. As the costs of statin treatment are the single most important determinant of costs, policy decisions reduce to decisions on the acceptability of statin treatment for this risk group. Pending major changes in statin price, clear guidelines should be developed on how screen positive individuals should be treated, since not all of them have an elevated cholesterol level. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved. [ABSTRACT FROM PUBLISHER]

Aims The objective of this paper is to measure the potential burden of cardiovascular disease within the original Framingham Heart Study cohort by transforming its well-described epidemiological measures into time-based health policy measures, such as life years lost to or lived with the disease.Methods and Results We constructed multi-state life tables of the Framingham Heart Study cohort to calculate dwelling times with a history of cardiovascular disease. Age-specific probabilities determined transitions from healthy through disease to death. For this synthetic cohort, from age 50 men (women) live on average 26 (32) years; 20 (26) free of cardiovascular disease. Allowing occupancy of more than one disease state, 50-year-old males (females) live 2·9 (1·2) years with a history of myocardial infarction, 0·93 (1·2) with a history of stroke, and 0·67 (0·93) with congestive heart failure. Having ever suffered acute myocardial infarction, stroke or congestive heart failure, life expectancy is reduced by 9 (13), 12 (15) or 16 (16) years, respectively in 60-year-old men (women).Conclusions Transforming occurrence probabilities into time-based health measures, the prevalence of cardiovascular disease is remarkable: from age 50, 20% of remaining life expectancy is lived with the disease. Such measures are integral to appropriate health planning and assessment of the potential population health value of various treatment and prevention strategies. [ABSTRACT FROM PUBLISHER]

Aims: To compare the burden of cardiovascular disease in terms of lifetime risk and life years lived with disease between smokers and non-smokers., Methods and Results: We constructed multi-state life tables describing transitions through various cardiovascular diseases for 4723 smokers and non-smokers observed during 20 biannual observations in the Original Framingham Heart Study. Non-smokers live 8.66 (95% CI 7.61-9.63) (men) and 7.59 (95% CI 6.33-8.92) (women) years longer than smokers and more years free of cardiovascular disease: 6.22 (95% CI 5.09-7.30) years for males and 4.93 (95% CI 3.54-6.29) for females. But non-smokers spend more years with cardiovascular disease over the life course: 2.43 (95% CI 1.72-3.16) years for males and 2.66 (95% CI 1.87-3.38) years for females. The risk of cardiovascular disease before age 70 is higher among smokers, but over the entire lifecourse male non-smokers have higher risks of coronary heart disease, myocardial infarction, stroke and congestive heart failure, and female non-smokers have higher risks of coronary heart disease and congestive heart failure., Conclusion: Smoking, by shortening life, decreases both the probability and duration of cardiovascular disease throughout the life course. Non-smokers live many years longer and longer free of cardiovascular disease than smokers, but at the end of their life non-smokers will have lived longer with cardiovascular disease.