Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study

Marshall, Tom; Rouse, Andrew

doi:10.1136/bmj.325.7357.197

Cited by 48 publications

(43 citation statements)

References 16 publications

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“…Two studies were excluded as the results were presented in terms of costs per events avoided. 176,177 A further study was excluded as the evaluation explored the cost-effectiveness of statins in several international settings including the UK. 178 The results presented for the UK were not detailed and were generated for comparison between the countries by using country-specific costings only.…”

Section: Quantity and Quality Of Research Availablementioning

confidence: 99%

A systematic review and economic evaluation of statins for the prevention of coronary events

Ward

Jones²,

Pandor³

et al. 2007

Health Technol Assess

346

312

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, now part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs-led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in the NHS, the public and consumer groups and professional bodies such as r...

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Section: Quantity and Quality Of Research Availablementioning

confidence: 99%

A systematic review and economic evaluation of statins for the prevention of coronary events

Ward

Jones²,

Pandor³

et al. 2007

Health Technol Assess

346

312

View full text Add to dashboard Cite

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“…Moreover, if this cut-off point for CVD risk pre-stratification was used, only two-fifths of the total population would be required to attend their general practice for more time-and resource-consuming screening tests. This is supported by a modelling study by Marshall and Rouse, 24 which suggests that strategies preselecting patients for risk assessment may reduce staff time and prevent more new cases within available resources, compared with inviting all individuals. However, the authors used a hypothetical population, assuming default blood pressure and bloodcholesterol values for each individual, and used the Framingham score for pre-stratification.…”

Section: Comparison With Existing Literaturementioning

confidence: 71%

A simple risk score using routine data for predicting cardiovascular disease in primary care

Chamnan

Simmons²,

Sharp³

et al. 2010

Br J Gen Pract

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A total of 21 867 men and women aged 40-74 years, who were free from CVD and diabetes at baseline, participated in the study. The discrimination (the area under the receiver operating characteristic curve [aROC]), calibration, sensitivity/specificity, and positive/negative predictive value were evaluated for different risk thresholds of the Framingham risk equations and the Cambridge diabetes risk score (as an example of a simple risk score using routine data from electronic general practice records). ResultsDuring 203 ConclusionA risk score incorporating routinely available data from GP records performed reasonably well at predicting CVD events. This suggests that it might be more efficient to use routine data as the first stage in a stepwise population screening programme to identify people at high risk of developing CVD before more time-and resource-consuming tests are used.

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“…This has been done by Marshall and Rouse for alternative strategies for the primary prevention of cardiovascular disease [19]. They estimated what we have called expansion curves convex to the effectiveness axis in costeffectiveness space due to prioritisation of patients with a higher estimated risk of coronary heart disease.…”

Section: Expansion Curve Estimationmentioning

confidence: 99%

Non‐linearity in the cost‐effectiveness frontier

2006

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Conventional cost-effectiveness decision rules rely on the assumptions that all health care programmes are divisible and exhibit constant returns to scale for a homogeneous population; hence, the path between adjacent programmes on a cost-effectiveness frontier must be linear. In this paper we build a framework to analyse non-linear 'expansion' paths. We model the impact of two key sources of non-linearity: economies of scale or scope in the production of health care; and prioritisation of patients who are most likely to benefit from more expensive and more effective treatments. We conclude that the expansion path might be linear, convex or concave, depending on the situation. The path might also exhibit vertical discontinuity due to fixed costs or horizontal discontinuity due to indivisibility. The efficiency of resource allocation might be improved by empirical estimation of expansion paths. We discuss the advantages and disadvantages of this approach compared with a standard stratified analysis.

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Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study

Abstract: Objective To develop a model to determine resource costs and health benefits of implementing guidelines for the prevention of cardiovascular disease in primary care.

Cited by 48 publications

References 16 publications

A systematic review and economic evaluation of statins for the prevention of coronary events

A systematic review and economic evaluation of statins for the prevention of coronary events

A simple risk score using routine data for predicting cardiovascular disease in primary care

Non‐linearity in the cost‐effectiveness frontier

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