Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

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    Delphine De Smedt
    Correspondence
    Corresponding author.
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    Department of Public Health, Ghent University, Ghent, Belgium
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    Lieven Annemans
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    Department of Public Health, Ghent University, Ghent, Belgium
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    Guy De Backer
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    Department of Public Health, Ghent University, Ghent, Belgium
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    Kornelia Kotseva
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    Department of Public Health, Ghent University, Ghent, Belgium

    International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK
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    Lars Rydèn
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    Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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    David Wood
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    International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK
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    Philippe Amouyel
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    Institut Pasteur de Lille, Université de Lille, France
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    Jan Bruthans
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    Centre for Cardiovascular Prevention, 1st Medical Faculty Charles University and Thomayer Hospital, Prague, Czech Republic
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    Renata Cifkova
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    Centre for Cardiovascular Prevention, 1st Medical Faculty Charles University and Thomayer Hospital, Prague, Czech Republic
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    Johan De Sutter
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    Department of Internal Medicine, Ghent University, Belgium
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    Marina Dolzhenko
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    Department of Cardiology, Shupyk's National Medical Academy of Postgraduate Education, Kiev, Ukraine
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    Andrejs Erglis
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    University of Latvia, Pauls Stradins Clinical University Hospital, Riga, Latvia
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    Nina Gotcheva
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    Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
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    Viveca Gyberg
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    Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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    Aleksandras Laucevicius
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    Clinic of Cardiovascular Diseases of Vilnius University, Heart and Vascular Medicine of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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    Dragan Lovic
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    Clinic for Internal Medicine Intermedica, Nis, Serbia
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    Rafael Oganov
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    National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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    Andrzej Pajak
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    Jagiellonian University Medical College, Faculty of Health Sciences, Department of Epidemiology and Population Studies, Kracow, Poland
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    Nana Pogosova
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    Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention, National Research Centre for Preventive Medicine, Moscow, Russia
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    Željko Reiner
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    University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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    Martin Stagmo
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    Department of Heart Failure and Valve Disease, Skane University Hospital, Lund, Sweden
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    Dirk De Bacquer
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    Department of Public Health, Ghent University, Ghent, Belgium
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      Highlights

      • Guidelines adherence is more cost-effective in higher risk patients.
      • The room for improvement is a key driver of the ICER.
      • Depending on the method used better or worse outcomes were found.

      Abstract

      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€/QALY was calculated. The ICER lowered to 29,093€/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€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/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€/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.

      Keywords

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