PhD ceremony: C. Boersma, 13.15 uur, Academiegebouw, Broerstraat 5, Groningen
Thesis: Health-economics of cardiovascular and renal disease prevention. From clinical trial to real-life settings
Promotor(s): prof. M.J. Postma, prof. L.T.W. de Jong-van den Berg, prof. P.E. de Jong
Faculty: Mathematics and Natural Sciences
Cornelis Boersma evaluated in his thesis different epidemiological and health-economic aspects of preventive interventions in patients at increased cardiovascular and renal risk. In the last decades, cardiovascular and renal disease are leading causes of morbidity and mortality in the developed world resulting in enormous and growing burdens for health-care budgets. Therefore, prevention of cardiovascular disease events and prevention of progression to end-stage renal disease will remain very important. Currently, pharmacotherapeutic treatment is generally inititated in subjects with previous cardiovascular events or confirmed renal disease (secondary prevention). This re-active approach does not specifically identify the generally healthy subjects and is based on treatment of established risk-factors (e.g. hypertension, hypercholesterolemia, diabetes). Elevated albuminuria is more and more recognized as an early predictor of cardiovascular and renal disease in specific patient populations (e.g. diabetes, hypertension) and even in the general population. Next to the re-active approach, it has been suggested that active population-based screening for albuminuria could enable early identification and prevention of cardiovascular and renal disease.
In summary, it has been shown in this thesis that treatment with RAAS intervening agents (ARBs and ACE-inhibitors) in subjects at elevated cardiovascular and renal risk is likely to be cost-effective in preventing cardiovascular and/or renal diseases. Early intervention may be more optimal in that respect. Several studies in this thesis emphasize the importance of combining both clinical trial as well as observational data to support evidence-based decisions on health-care interventions and use of pharmacotherapeutic agents. Furthermore, the analyses in this thesis suggest potential favourable cost-effectiveness of active screening for (micro)albuminuria in the general population. These results were based on both data from clinical trials and observational data, and are therefore likely to be representative for ‘real-life’ settings. The results from this thesis ideally lead to increased awareness of the impact of albuminuria in clinical practice and offer health-care decisionmakers tools to seriously consider implementation of a population-based screening that is directed at albuminuria.
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