Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease : results from the EUROASPIRE IV survey
Autor: | Renata Cifkova, Žjelko Reiner, Viveca Gyberg, Lieven Annemans, David R. Wood, Nana Pogosova, Jan Bruthans, Phillippe Amouyel, Aleksandras Laucevičius, Marina Dolzhenko, Lars Rydén, Dirk De Bacquer, Delphine De Smedt, Rafael G. Oganov, Guy De Backer, Nina Gotcheva, Andrzej Pajak, Andrejs Erglis, Dragan Lovic, Johan De Sutter, Martin Stagmo, Kornelia Kotseva |
---|---|
Přispěvatelé: | Imperial College Healthcare NHS Trust - CLRN Funding, Imperial College Healthcare NHS Trust, Public Health Sciences, Vriendenkring VUB, Clinical sciences |
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
Cardiac & Cardiovascular Systems Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis Coronary Disease Disease 030204 cardiovascular system & hematology 0302 clinical medicine Older patients Medicine 030212 general & internal medicine guidelines EUROASPIRE 1102 Cardiorespiratory Medicine and Haematology health care economics and organizations BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina Framingham Risk Score Secondary prevention ASSOCIATION Middle Aged humanities Coronary heart disease Europe DENSITY-LIPOPROTEIN CHOLESTEROL Practice Guidelines as Topic TRIAL Female Guideline Adherence Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine secondary prevention cost-effectiveness coronary heart disease medicine.drug INTERVENTIONS medicine.medical_specialty EZETIMIBE Guidelines EVENTS 03 medical and health sciences Ezetimibe Internal medicine Humans In patient BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine METAANALYSIS Aged Science & Technology business.industry Decision Trees SMOKING-CESSATION THRESHOLDS Cardiovascular System & Hematology Cardiovascular System & Cardiology Smoking cessation Cost-effectiveness business STATIN TREATMENT |
Zdroj: | International Journal of Cardiology Volume 272 |
ISSN: | 0167-5273 |
Popis: | 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(sic)/QALY was calculated. The ICER lowered to 29,093(sic)/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 (= 20%) instead of high-cholesterol patients lowered the ICER to 28,064(sic)/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(sic)/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. 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 lessstringent LDL target ( |
Databáze: | OpenAIRE |
Externí odkaz: |