Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project

Smedt, Delphine De; Kotseva, Kornelia; Bacquer, Dirk De; Wood, David; Backer, Guy De; Dallongeville, Jean; Lehto, Seppo; Pająk, Andrzej; Reiner, Željko; Vanuzzo, Diego; Georgiev, B.; Gotcheva, Nina; Annemans, Lieven

doi:10.1093/eurheartj/ehs210

Cited by 63 publications

(41 citation statements)

References 41 publications

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“…These results are in line with a simulation study in CAD patients from 8 European countries, which showed that, by optimizing cardiovascular prevention in individuals (smoking cessation, diet and exercise, and better management of SBP and/or LDL‐c), a mean of ≈0.25 QALYs (3 months in perfect health) could be gained 38. The moderate health benefit to be obtained with intensive LLT may be attributable to the higher risk of nonvascular death in this secondary prevention setting, which is not decreased by LLT.…”

Section: Discussionsupporting

confidence: 87%

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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BackgroundA validated prediction model estimates the absolute benefit of intensive versus standard lipid‐lowering therapy (LLT) with statins on next major cardiovascular events for individual patients with coronary artery disease. We aimed to assess whether targeting intensive LLT therapy to coronary artery disease patients with the highest predicted absolute benefit is cost‐effective compared to treating all with standard or all with intensive LLT.Methods and ResultsA lifetime Markov model was constructed for coronary artery disease patients (n=10 000) with mean age 61 years. Number of major cardiovascular events, (non) vascular death, costs, and quality‐adjusted life years (QALYs) were estimated for the following strategies: (1) standard LLT for all (reference strategy); (2) intensive LLT for those with 5‐year absolute major cardiovascular events risk reduction (ARR) ≥3%, ≥2.3%, or ≥1.5% (corresponding to ≥20%, ≥15%, or ≥10% 5‐year major cardiovascular events risk); and (3) intensive LLT for all. With intensive LLT for those with ≥3% 5‐year ARR (13% of patients), 380 QALYs were gained for €2423/QALY. Using a threshold of ≥2.3% ARR (26% of patients), 630 QALYs were gained for €5653/QALY. Using a threshold of ≥1.5% ARR (56% of patients), 1020 QALYs were gained for €10 960/QALY. By treating all intensively, 1410 QALYs were gained (0.14 QALY per patient) for €17 223/QALY. With benefit‐based treatment, 0.16 to 0.17 QALY was gained per treated patient.ConclusionsIntensive LLT with statins for all coronary artery disease patients results in the highest overall QALY gain against acceptable costs. However, the number of QALYs gained with intensive LLT by statins in individual patients can be increased with selective benefit‐based treatment.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835

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Section: Discussionsupporting

confidence: 87%

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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“…Recent studies, such as EUROACTION and Global Secondary Prevention Strategies to Limit (GOSPEL) studies, provided scientific evidence for the beneficial effect and improved prognosis in patients with CHD (25,26). A health economics analysis from EUROASPIRE III showed favorable results with an average incremental cost-effectiveness ratio (ICER) of Euro12,484 per quality-adjusted life year (QALY) (27).…”

Section: Discussionmentioning

confidence: 99%

The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention

Kotseva

2017

Cardiovasc. Diagn. Ther.

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The Joint European Societies (JES) guidelines on cardiovascular disease (CVD) prevention published in 1994, 1998, 2003, 2007, 2012 and 2016 defined lifestyle and risk factors targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. Guideline implementation in Europe has been evaluated with four cross-sectional EUROASPIRE surveys starting in mid-1990s. The results showed poor lifestyle and risk factor management in patients with CHD and in high CVD risk people with high prevalences of smoking, obesity, central obesity and diabetes. The control of blood pressure, lipids and glucose was far from optimal. A comparison across the recent three surveys provided a unique description of time trends for secondary prevention over a period of 14 years. The results showed adverse lifestyle trends, a substantial increase in obesity, central obesity and diabetes. Despite significant improvement of blood pressure and lipid control many patients were not reaching the risk factor goals and there was no change in glucose control. Comparing the most recent two surveys, there were no major differences in lifestyle and risk factor management in people at high risk of developing CVD. A new approach to CVD prevention integrating primary and secondary prevention into a modern preventive cardiology programme, focusing on lifestyle and risk factor management is required, in order to reduce the risk of CVD events and improve quality of life in patients with CHD and those at high risk of developing CVD.

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“…12,13,19 Cholesterol lowering using statins 15,16 and improvement in BP control are cost effective if targeted at persons with high CV risk. 22 Importantly, a sizable portion of patients on lipid-lowering or BP-lowering drug treatment fails to take their treatment adequately or to reach therapeutic goals, 23,24 with clinical and economic consequences.…”

Section: Cost-effectiveness Of Preventionmentioning

confidence: 99%

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Piepoli¹,

Hoes²,

et al. 2016

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Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project

Abstract: These results underscore the societal value of optimizing prevention in most patients with established CHD, but also highlight the need for setting priorities towards patients more at risk and the need for more studies comparing intensified prevention with usual care in these patients.

Cited by 63 publications

References 41 publications

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention

2016 European Guidelines on cardiovascular disease prevention in clinical practice

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