The Vascular Risk Foundation has adopted a new risk calculator that includes a Health Technology Assessment comparing statins, ezetimibe and PCSK9-Inhibitors. The Excel based information contains unique features about risk prediction in primary prevention (with inclusion of arterial age, if desired), and in secondary prevention as well as a direct comparison of cost-efficiency analysis comparing major lipid lowering drug categories. The calculator can be downloaded here.
The only reason for the existence of cost-efficiency analysis (CEA) is rationing of effective medical therapies. Ineffective and effective medical therapies are defined by the guidelines and not by economical calculations. According to ethical principles, indicated medical therapies should be delivered to every individual (justice principle of Beauchamp and Childress). The choosing wisely Charta is an economical one: “The medical profession must promote justice in the health care system, including the fair distribution of health care resources”. This inclusion has not been a matter of sufficient debate in societies and there is no class I indication based on medical evidence, that such a “”must”” recommendation should be adopted in clinical practice. It has never been shown, that rationed money was more appropriately used elsewhere.
It is of high importance, that physicians understand the strengths and limitations of cost-efficiency assessments in medicine. Our calculator was designed as a teaching tool.