期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 272, 期 -, 页码 20-25出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2018.06.104
关键词
Secondary prevention; Guidelines; Cost-effectiveness; Coronary heart disease; EUROASPIRE
资金
- AstraZeneca
- Bristol Myers Squibb/Emea Sarl
- GlaxoSmithKline
- F Hoffman-La Roche
- Merck
- Sharp Dohme
- Amgen
- European Society of Cardiology, EURObservational Research Programme
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 (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591(sic)/QALY and intensifying cholesterol treatment in high-risk patients (>= 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. (C) 2018 Elsevier B.V. All rights reserved.
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