The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands.
BACKGROUND
A new Dutch guideline for cardiovascular disease management substantially extends the number of individuals for whom treatment with statins and/or antihypertensive agents is recommended. We estimated the cost-effectiveness of implementing the new guideline at the national level.


METHODS
First, the number of currently untreated individuals who would become eligible for cholesterol-lowering or antihypertensive treatment under the new guideline was estimated using data from a recent population study. Cost-effectiveness of treating this group of patients was then assessed using a mathematical model.


RESULTS
Implementing the guideline in the age category 30-69 years would lead to an additional 465,000 individuals requiring treatment. Over a period of 20 years, the cumulative incidence of acute myocardial infarction in the whole population would drop by 3.0%, that of stroke by 3.9%, and all-cause mortality would drop by 0.9%. The lifetime cost-effectiveness ratio was calculated to be 15,000 Euro per quality-adjusted life year gained. In the age categories 70-79 years and 80 years or above, an additional 600,000 and 450,000 persons, respectively, would need to be treated, resulting in corresponding reductions in cumulative incidences of 14 and 18% (acute myocardial infarction), 17 and 22% (stroke), and 1.2 and 0.6% (all-cause mortality) with cost-effectiveness ratios of 20,800 and 32,300 Euro, respectively, per quality-adjusted life year.


CONCLUSIONS
Complete implementation of the new guideline would lead to a considerable increase in the number of individuals requiring treatment. This would be cost-effective up to the age of 70 years.
Kok
Linda
L
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Engelfriet
Peter
P
Jacobs-van der Bruggen
Monique A M
MA
Hoogenveen
Rudolf T
RT
Boshuizen
Hendriek C
HC
Verschuren
Monique W M
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors