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Reliable estimates of the impacts of adverse events on health and healthcare costs are needed to evaluate the net effects of health interventions.

Researchers from HERC and CTSU have recently published a study in Circulation which generated such estimates using data from the HPS2-THRIVE trial (Heart Protection Study 2 – Treatment of HDL to Reduce the Incidence of Vascular Events) and used them to evaluate the net effects of 2g of extended-release niacin-laropiprant daily in this study of 25,000 participants aged 50 to 80 years with previous cardiovascular disease.

The detailed information on adverse events, deaths, hospitalisations, and quality of life of the HPS2-THRIVE participants were used to estimate the impact of a range of vascular and nonvascular adverse events on annual hospital costs and health-related quality of life (measured using the EQ-5D). Stroke, heart failure, musculoskeletal events, gastrointestinal events, and infections were all associated with significant decreases in quality of life in both the year of the event and in subsequent years. All serious vascular and nonvascular events were associated with substantial increases in hospital care costs.

These estimates were then used to evaluate the net effect of treatment with niacin-laropiprant versus placebo on quality-adjusted life years (QALYs) and costs in the study. It was found that participants allocated to niacin-laropiprant experienced fewer QALYs and accrued greater hospital care costs. Over the 4 years of follow-up in HPS2-THRIVE this corresponds to 300 fewer years of life in good health and increased hospital care costs of £1.3 million.