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
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