Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey (CROSBI ID 275360)
Prilog u časopisu | izvorni znanstveni rad | međunarodna recenzija
Podaci o odgovornosti
De Smedt, Delphine ; Annemans, Lieven ; De Backer, Guy ; Kotseva, Kornelia ; Rydèn, Lars ; Wood, David ; Amouyel, Philippe ; Bruthans, Jan ; Cifkova, Renata ; De Sutter, Johan ; Dolzhenko, Marina ; Erglis, Andrejs ; Gotcheva, Nina ; Gyberg, Viveca ; Laucevicius, Aleksandras ; Lovic, Dragan ; Oganov, Rafael ; Pajak, Andrzej ; Pogosova, Nana ; Reiner, Željko ; Stagmo, Martin ; De Bacquer, Dirk
engleski
Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey
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.
secondary prevention ; guidelines ; cost-effectiveness ; coronary heart disease ; EUROASPIRE
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Podaci o izdanju
272
2018.
20-25
objavljeno
0167-5273
1874-1754
10.1016/j.ijcard.2018.06.104
Povezanost rada
Kliničke medicinske znanosti