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Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease : Results from the EUROASPIRE IV survey

De Smedt, Delphine; Annemans, Lieven; De Backer, Guy LU ; Kotseva, Kornelia; Rydèn, Lars; Wood, David; Amouyel, Philippe; Bruthans, Jan; Cifkova, Renata and De Sutter, Johan, et al. (2018) In International Journal of Cardiology 272. p.20-25
Abstract

Background: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. Methods: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). Results: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was... (More)

Background: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. Methods: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). Results: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. Conclusion: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.

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type
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publication status
published
subject
keywords
Coronary heart disease, Cost-effectiveness, EUROASPIRE, Guidelines, Secondary prevention
in
International Journal of Cardiology
volume
272
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85054124301
ISSN
0167-5273
DOI
10.1016/j.ijcard.2018.06.104
language
English
LU publication?
no
id
23119d0c-884e-454e-b43c-bd1b8af794c2
date added to LUP
2018-10-29 14:10:53
date last changed
2019-11-13 05:19:00
@article{23119d0c-884e-454e-b43c-bd1b8af794c2,
  abstract     = {<p>Background: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. Methods: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). Results: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (&lt;2.5 mmol/L vs. &lt;1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. Conclusion: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.</p>},
  author       = {De Smedt, Delphine and Annemans, Lieven and De Backer, Guy and Kotseva, Kornelia and Rydèn, Lars and Wood, David and Amouyel, Philippe and Bruthans, Jan and Cifkova, Renata and De Sutter, Johan and Dolzhenko, Marina and Erglis, Andrejs and Gotcheva, Nina and Gyberg, Viveca and Laucevicius, Aleksandras and Lovic, Dragan and Oganov, Rafael and Pajak, Andrzej and Pogosova, Nana and Reiner, Željko and Stagmo, Martin and De Bacquer, Dirk},
  issn         = {0167-5273},
  keyword      = {Coronary heart disease,Cost-effectiveness,EUROASPIRE,Guidelines,Secondary prevention},
  language     = {eng},
  pages        = {20--25},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease : Results from the EUROASPIRE IV survey},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2018.06.104},
  volume       = {272},
  year         = {2018},
}