OBJECTIVES: Icosapent ethyl group (Vazkepa) reduces the risk of cardiovascular (CV) disease recurrence in statin-treated patients with elevated levels of triglycerides. Clinical practice variations and uneven implementation of effective and cost-effective healthcare technologies are a key challenge for healthcare systems which may lead to suboptimal treatment and in turn efficiency losses, increased costs, and health losses. This study aims to subcategorize the expected value of perfect implementation (EVPIM) to estimate the absolute and relative value of eliminating slow, low, and delayed implementation of Vazkepa in Sweden and by Swedish regions.

METHODS: This study estimates the effects of optimal (perfect) and actual implementation in Sweden from Swedish hospitals after incident events in a five-year perspective by combining cost-effectiveness evidence with epidemiology from publicly available data from Swedeheart registry. The implementation analysis is based on the EVPIM framework by Fenwick et al. which estimates the value of increasing implementation from the current level up to a perfect level.

RESULTS: EVPIM estimates the absolute and relative value of eliminating different parts of the suboptimal implementation. Preliminary results show that 84 % of the suboptimal implementation is represented by low implementation, and 16 % by slow implementation. The total EVPIM estimates are 936 QALYs and SEK 468 million, equal to a cost of SEK 18 960 per patient. Thus, it is estimated that by eliminating low and slow implementation at least, 1 869 CV events may be avoided over a five-year period, including 159 deaths, 145 strokes, and 480 myocardial infarctions.

CONCLUSIONS: An EVPIM estimate of SEK 468 million implies that implementation strategies up to this value are cost-effective. The results also show the health loss that may be avoided by eliminating the suboptimal implementation strategies. This may help decision makers identify what part of the suboptimal implementation is contributing to the largest share of the total EVPIM.