Stephen J.LurieMD, PhD, Senior Editor
To the Editor: Dr Tice and colleagues1 reported that homocysteine-lowering therapy may be cost-effective in preventing coronary heart disease in a variety of populations. However, we have 2 concerns.
First, is the Coronary Heart Disease Policy Model still valid? While this model has been extremely useful in modeling outcomes in cardiovascular disease in the past, the parameters of the model were derived from a variety of sources that date back to 1990. However, the epidemiology of cardiovascular risk factors has changed over the past decade. Tice et al do not mention the parameters having been updated, potentially limiting the validity of the model for the early 21st century.
Sunder-Plassmann G, Födinger M. Cost-effectiveness of Homocysteine-Lowering Therapy to Prevent Coronary Heart Disease. JAMA. 2002;287(2):190–191. doi:10.1001/jama.287.2.190-JLT0109-3-2
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