COST-EFFECTIVENESS OF GUIDELINE ADHERENCE IN CORONARY PATIENTS- THE IMPACT OF THE METHODOLOGY.
Author(s)
De Smedt D1, Annemans L2, Kotseva K3, Wood D3, De Backer G1, Rydén L4, De Bacquer D1
1Ghent University, Gent, Belgium, 2Ghent University, Ghent, Belgium, 3National Heart & Lung Institute, Imperial College London, London, UK, 4Karolinska Universitetssjukhuset/Solna, Stockholm, Sweden
OBJECTIVES: The European guidelines on cardiovascular disease (CVD) prevention inform clinicians about risk factor goals and appropriate treatment options in order to reduce recurrent cardiovascular events. Knowledge about the cost-effectiveness of a comprehensive approach to tackle uncontrolled CVD risk factors is however limited and questions about the preferred methodology to assess such effect remain unsolved. The aim of this study was to assess how the cost-effectiveness outcome is influenced by the methodology. METHODS: Analyses are based on data from 4,663 coronary patients across 13 European countries collected during the cross-sectional EUROASPIRE IV survey. An individual-based decision tree, with a 10-year time horizon was developed to model the cardiovascular risk. Personalized optimal CVD prevention was simulated and compared with current care. Future CVD risk was modelled using the SMART risk prediction calculator. A first model (model A) calculated the individual 10-year risk by applying the risk predictor twice for each patient profile, once for the current care group, and once for the optimized prevention group. The alternative model (model B) used the same method for the current care group, but applied published risk reduction to each individual in the optimized prevention group accounting for their treatment scheme. RESULTS: The mean estimated 10-year risk for a recurrent vascular event amounted to 20.13% in the current care group. According to model A, initiating maximal guideline adherence is associated with an absolute risk reduction of 1.53%, resulting in an ICER of €52,968/QALY. When applying model B, initiating maximal guideline adherence is associated with an absolute risk reduction of 2.48%, resulting in an ICER of €31,509/QALY. CONCLUSIONS: The method used has a major impact on the ICER. Longitudinal follow up data are needed to test the performance of both modelling methods in order to inform us about the preferred option.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PCV93
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders