RESEARCH Drug Treatment and Cost of Cardiovascular Disease in Australia Zanfina Ademi, 1 Danny Liew, 2 Derek Chew, 3 Greg Conner, 4 Louise Shiel, 1 Mark Nelson, 5 Ash Soman, 6 Gabriel Steg, 7 Deepak L. Bhatt 8 & Christopher Reid 1 on behalf of the REACH registry investigators 1 Department of Epidemiology and Preventive Medicine, Centre for Cardiovascular Research and Education in Therapeutics, Monash University, Victoria, Australia 2 Department of Medicine (St Vincent Hospital), University of Melbourne, Victoria, Australia 3 Department of Cardiology, Flinders Medical Centre, South Australia, Australia 4 Liverpool Hospital, New South Wales, Australia 5 Menzies Research Institute, University of Tasmania, Tasmania, Australia 6 Sanofi-Aventis, Australia 7 INSERM U-698, Universit ´ e Paris 7 and AP-HP, Paris, France 8 VA Boston Healthcare System and Brigham and Women’s Hospital, Boston, MA, USA Keywords Average annual costs; Cardiovascular disease; Medicine. Correspondence Zanfina Ademi, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne VIC 3004, Australia. Tel.: +61(0)990-30052; Fax: +613-990-30594; E-mail: Zanfina.Ademi@med.monash.edu.au doi: 10.1111/j.1755-5922.2009.00090.x Australia’s Pharmaceutical Benefits Scheme supports the use of effective drugs for the prevention and control of cardiovascular risk factors. However, there are little data available describing per person costs of medication in primary prevention and secondary prevention in the community. We aim to under- stand annual expenditure on cardiovascular medicines according to the level and extent of cardiovascular disease, using participants enrolled in the Re- duction of Atherothrombosis for Continued Health (REACH) registry. 2873 participants were recruited into the REACH registry through 273 Australian general practices. Cardiovascular medicines review was undertaken at base- line. Average weighted costs of medications were estimated using government- reimbursed prices. Annual costs were stratified by disease extent and location. The annual mean cost of pharmaceuticals per person was AU$1307. The aver- age reported medicine use per person across all states and participants groups varied significantly. Participants with cerebrovascular or peripheral arterial dis- ease were prescribed less cardiovascular medication than those with coronary artery disease (CAD) (mean number of drugs 3.5 vs. 4.5, P < 0.0001) and (3.6 vs. 4.5, P < 0.0001), while those with risk factor alone had the same medica- tion use as those with CAD (mean number 4.5). Medication use was lower in Western Australia in comparison to eastern States. Participants with existing cerebrovascular disease and peripheral vascular disease receive less preven- tive therapy than those with CAD or even risk factors alone. This observation is consistent across all mainland states. Given the evidence of the effective- ness and cost-effectiveness of treating all types of vascular diseases, the present study suggests that there is scope to improve the treatment of these high-risk participants in Australia. Introduction Pharmaceuticals comprise one of the fastest growing costs within the Australian health care system. The current cost of the Pharmaceutical Benefit Scheme (PBS) is approxi- mately AU$6.8 billion per year, of which 84% is met by the federal government and the remainder by patient via co-payments [1]. Atherothrombosis remains the most common cause of morbidity and mortality in Australia and poses a significant economic burden [2,3]. It is the common pathophysiological link shared by all major clinical manifestations of vascular disease (e.g., coronary heart disease, stroke, and peripheral arterial disease) [4,5]. Medicines for the primary and secondary prevention of atherothrombotic diseases dominate PBS expenditures. 164 Cardiovascular Therapeutics 27 (2009) 164–172 c  2009 Blackwell Publishing Ltd