Population-Level Impact Assessment of the Revised Dyslipidemia Prescription Protocol in Greece Using Simulation Modeling
Author(s)
Panos Stafylas, MD, MSc, PhD1, Christiana Tychala, BSc, MSc1, Demosthenes Panagiotakos, BSc, PhD2, Dimitri Richter, MD, PhD3, Alexandros Ginis, MD, PhD4, Christos Stafylas, BSc5, Konstantinos Papadopoulos, BSc4, Marilena Lolaka, BSc4, Angeliki Avgitidou, BSc, PhD1, Konstantinos Kaparis, BSc, PhD6, Vassilis Homer Aletras, BSc, PhD6, Andreas Georgiou, BSc, PhD6, Evangelos Liberopoulos, MD, PhD7, Charalambos Vlachopoulos, MD, PhD8.
1HealThink, Thessaloniki, Greece, 2Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece, 3Cardiology Department, Euroclinic Hospital, Athens, Greece, 4ELPEN Pharmaceutical SA, Athens, Greece, 5School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6Department of Business Administration, University of Macedonia, Thessaloniki, Greece, 71st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 8First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodis, Athens, Greece.
1HealThink, Thessaloniki, Greece, 2Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece, 3Cardiology Department, Euroclinic Hospital, Athens, Greece, 4ELPEN Pharmaceutical SA, Athens, Greece, 5School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6Department of Business Administration, University of Macedonia, Thessaloniki, Greece, 71st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 8First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodis, Athens, Greece.
OBJECTIVES: Dyslipidemia affects over 40% of Greek adults, with persistent gaps in diagnosis and treatment. This study aims to evaluate the 5-year clinical and economic impact of the recently revised national prescription protocol (NPP) for dyslipidemia using a discrete-event simulation (DES) model.
METHODS: A DES model was developed in Simul8 to simulate the Greek adult population segmented into four cardiovascular risk groups and six treatment strategies (including not treated). Epidemiology, cost, and treatment effect were derived from national studies, real-world registries, RCTs, official national statistics and other public sources. Outcomes included major cardiovascular events (CVEs), cardiovascular mortality, and direct medical costs. Analysis was performed from a third-party payer perspective. Model design followed ISPOR-SMDM Good Modeling Practices, with transparency and internal validation steps included.
RESULTS: Over a 5-year horizon, the model projected 527,100 major CVEs, with 43% occurring in the very high-risk group (15% of the population). Despite increased treatment uptake following the implementation of the revised NPP, a substantial proportion of high-risk patients remained undertreated, while many moderate-risk individuals remained untreated. Although drug-related expenditures were projected to increase, these were partially offset by a reduction in the costs associated with managing CVEs. The total projected drug cost over 5 years was over €770 million, accounting for only 22% of the total direct medical costs, indicating potential cost savings through improved risk-targeted prevention.
CONCLUSIONS: The DES model demonstrated that the recently revised NPP can influence population-level outcomes, especially among high-risk groups. Simulation modeling enables policymakers to assess alternative treatment pathways and reimbursement strategies and forecast their cost and outcome implications. Integration of RWD into such models will further improve their value in routine decision-making.
METHODS: A DES model was developed in Simul8 to simulate the Greek adult population segmented into four cardiovascular risk groups and six treatment strategies (including not treated). Epidemiology, cost, and treatment effect were derived from national studies, real-world registries, RCTs, official national statistics and other public sources. Outcomes included major cardiovascular events (CVEs), cardiovascular mortality, and direct medical costs. Analysis was performed from a third-party payer perspective. Model design followed ISPOR-SMDM Good Modeling Practices, with transparency and internal validation steps included.
RESULTS: Over a 5-year horizon, the model projected 527,100 major CVEs, with 43% occurring in the very high-risk group (15% of the population). Despite increased treatment uptake following the implementation of the revised NPP, a substantial proportion of high-risk patients remained undertreated, while many moderate-risk individuals remained untreated. Although drug-related expenditures were projected to increase, these were partially offset by a reduction in the costs associated with managing CVEs. The total projected drug cost over 5 years was over €770 million, accounting for only 22% of the total direct medical costs, indicating potential cost savings through improved risk-targeted prevention.
CONCLUSIONS: The DES model demonstrated that the recently revised NPP can influence population-level outcomes, especially among high-risk groups. Simulation modeling enables policymakers to assess alternative treatment pathways and reimbursement strategies and forecast their cost and outcome implications. Integration of RWD into such models will further improve their value in routine decision-making.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD89
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Health Technology Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas