Early Health Technology Assessment and Cost-Effectiveness of the National Cardiovascular Disease Prevention Program in Greece
Author(s)
Panos Stafylas, MD, MSc, PhD1, Charalambos Vlachopoulos, MD, PhD2, Evangelos Liberopoulos, MD, PhD3, Dimitri Richter, MD, PhD4, Christos Stafylas, BSc5, Alexandros Ginis, BSc, PhD6, Christiana Tychala, BSc, MSc1, Panagiotis Katrapas, MD, PhD6, Konstantinos Kaparis, BSc, PhD7, Andreas Georgiou, BSc, PhD7, Vassilis Homer Aletras, BSc, PhD7, Demosthenes Panagiotakos, MD, PhD8.
1HealThink, Thessaloniki, Greece, 2First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodis, Athens, Greece, 31st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 4Cardiology Department, Euroclinic Hospital, Athens, Greece, 5School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6ELPEN Pharmaceutical SA, Athens, Greece, 7Department of Business Administration, University of Macedonia, Thessaloniki, Greece, 8Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
1HealThink, Thessaloniki, Greece, 2First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodis, Athens, Greece, 31st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 4Cardiology Department, Euroclinic Hospital, Athens, Greece, 5School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6ELPEN Pharmaceutical SA, Athens, Greece, 7Department of Business Administration, University of Macedonia, Thessaloniki, Greece, 8Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
OBJECTIVES: Cardiovascular disease (CVD) remains the leading cause of mortality in Greece, accounting for approximately 40% of annual deaths and an estimated economic burden of €4.3 billion. In response, the Ministry of Health has recently launched the National Cardiovascular Disease Prevention Program (NCVPP), targeting 5.5 million adults aged 30-70 years without known CVD. The objective of this study is to conduct an early health technology assessment (HTA) of the NCVPP to evaluate its potential clinical outcomes, cost implications, and cost-effectiveness, thereby informing policy decisions on its implementation and optimization.
METHODS: A Discrete Event Simulation (DES) model was developed using SIMUL8, following ISPOR-SMDM Modeling Good Research Practices. The model simulated population transitions across four CVD risk categories, incorporating RWD from national registries, ATTICA and EMENO studies, and official cost sources (MoH DRGs, EOPYY tariffs, 2024 drug price bulletins). The model captured management pathways including screening, lipid-lowering therapies (LLTs), clinical/laboratory monitoring, and hospitalizations for major CVD events. A conservative scenario was applied assuming a 40% reduction in undiagnosed dyslipidemia and a 20% increase in appropriate LLT among high- and very high-risk individuals. Effects on smoking cessation and blood pressure control were not modeled. Analysis was conducted over a 5-year time horizon from the third-party payer perspective.
RESULTS: The NCVPP was projected to prevent 13,700 major CVD events (10,100 non-fatal; 3,600 fatal). The incremental program cost was €144 million, driven by expanded screening and treatment uptake, partially offset by reductions in CVD event-related costs. The incremental cost-effectiveness ratio (ICER) was €10,510 per major CVD event avoided - well below typical willingness-to-pay thresholds.
CONCLUSIONS: The NCVPP appears highly cost-effective under conservative assumptions. DES modeling supports robust early HTA of public health programs, offering decision-makers insights into scalability and resource impact. Future iterations may include integration of real-world program outcomes, quality-adjusted life years (QALYs) and additional intervention components.
METHODS: A Discrete Event Simulation (DES) model was developed using SIMUL8, following ISPOR-SMDM Modeling Good Research Practices. The model simulated population transitions across four CVD risk categories, incorporating RWD from national registries, ATTICA and EMENO studies, and official cost sources (MoH DRGs, EOPYY tariffs, 2024 drug price bulletins). The model captured management pathways including screening, lipid-lowering therapies (LLTs), clinical/laboratory monitoring, and hospitalizations for major CVD events. A conservative scenario was applied assuming a 40% reduction in undiagnosed dyslipidemia and a 20% increase in appropriate LLT among high- and very high-risk individuals. Effects on smoking cessation and blood pressure control were not modeled. Analysis was conducted over a 5-year time horizon from the third-party payer perspective.
RESULTS: The NCVPP was projected to prevent 13,700 major CVD events (10,100 non-fatal; 3,600 fatal). The incremental program cost was €144 million, driven by expanded screening and treatment uptake, partially offset by reductions in CVD event-related costs. The incremental cost-effectiveness ratio (ICER) was €10,510 per major CVD event avoided - well below typical willingness-to-pay thresholds.
CONCLUSIONS: The NCVPP appears highly cost-effective under conservative assumptions. DES modeling supports robust early HTA of public health programs, offering decision-makers insights into scalability and resource impact. Future iterations may include integration of real-world program outcomes, quality-adjusted life years (QALYs) and additional intervention components.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA118
Topic
Epidemiology & Public Health, Health Technology Assessment, Methodological & Statistical Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas