The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease.
OBJECTIVE
The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.


METHODS
Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.


RESULTS
The intervention strategy resulted in mean cost savings per patient of euro512.77 (95 percent confidence interval [CI], -1086.46-91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, -0.0101-0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay euro45,000 per additional QALY.


CONCLUSIONS
Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.
Gillespie
Paddy
P
National University of Ireland, Galway. paddy.gillespie@nuigalway.ie
O'Shea
Eamon
E
Murphy
Andrew W
AW
Byrne
Mary C
MC
Byrne
Molly
M
Smith
Susan M
SM
Cupples
Margaret E
ME
D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005194:Family Practice; D006801:Humans; D007494:Ireland; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics* / Q000379:methods; D011795:Surveys and Questionnaires