The cost-effectiveness of omega-3 supplements for prevention of secondary coronary events

PURPOSE

To project the clinical and economic benefits of omega-3 supplements for prevention of secondary (repeat) cardiovascular events in U.S. males.

DESIGN

Decision-analytic model.

METHODOLOGY

Model clinical probabilities (rates of fatal myocardial infarction [MI] and cardiovascular death) were based on published trials. Costs were derived from standard U.S. sources. Outcomes include deaths delayed, cost per death delayed, fatal MIs avoided, and cost per fatal MI avoided. Costs, outcomes, and cost-effectiveness were determined for the initial year and over a 42-month model period. Sensitivity analyses were conducted to evaluate the robustness of key model assumptions.

PRINCIPAL FINDINGS

According to the model, the use of omega-3 supplements results in fewer fatal MIs and fewer cardiovascular deaths in the short-term (1 year) and longterm (42-month) analyses. When including only direct medical treatment costs for fatal MIs, omega-3 supplementation is cost-effective compared to no supplementation. In terms of total costs (medical costs and decreased productivity), supplementation is cost-saving, providing better outcomes and lower/fewer costs. Supplementation remained cost-effective in all sensitivity analyses.

CONCLUSION

Under a variety of scenarios, omega-3 supplements are likely to improve health and lower total costs. Despite model limitations, omega-3 supplementation should be considered an important and cost-effective option for prevention of secondary cardiovascular events.

Some issues in risk assessment for agricultural chemicals

Risk assessment is now a significant feature of most environmental risk management programs, in both industry and government. The purpose of this paper is to describe the elements of risk assessment, their strengths and limitations, and their relationship to other activities, including research and risk management. Risk assessment issues to be examined are those especially important to the agricultural community, including problems of high-risk subpopulations, exposure through unauthorized pathways (e.g., those resulting from groundwater contamination or pesticide misuse), and inadequacies in toxicity and residue data bases.