title: Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project.
abstract: OBJECTIVE
  The EUROASPIRE III survey indicated that the guidelines on cardiovascular disease prevention are poorly implemented in patients with established coronary heart disease (CHD). The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in eight EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, and the U.K.). METHODS AND RESULTS The individual risk for subsequent cardiovascular events was estimated, based on published Framingham equations. Based on the EUROASPIRE III data, the type of suboptimal prevention, if any, was identified for each individual, and the effects of optimized tailored prevention (smoking cessation, diet and exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated. Costs of prevention and savings of avoided events were based on country-specific data. A willingness to pay threshold of €30,000/quality-adjusted life year (QALY) was used. The robustness of the results was validated by sensitivity analyses. Overall, the cost-effectiveness analyses for the eight countries showed mainly favourable results with an average incremental cost-effectiveness ratio (ICER) of €12,484 per QALY. Only in the minority of patients at the lowest risk for recurrent events, intensifying preventive therapy seems not cost-effective. Also, the single impact of intensified cholesterol control seems less cost-effective, possibly because their initial 2-year risk was already fairly low, hence the room for improvement is rather limited.
  
  
  CONCLUSIONS
  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.
authors: Ghent University, Gent, Belgium. delphine.desmedt@ugent.be
authors: Delphine
authors: D
authors: De Smedt
authors: Kornelia
authors: K
authors: Kotseva
authors: Dirk
authors: D
authors: De Bacquer
authors: David
authors: D
authors: Wood
authors: Guy
authors: G
authors: De Backer
authors: Jean
authors: J
authors: Dallongeville
authors: Lehto
authors: L
authors: Seppo
authors: Andrzej
authors: A
authors: Pajak
authors: Zeljko
authors: Z
authors: Reiner
authors: Diego
authors: D
authors: Vanuzzo
authors: Borislav
authors: B
authors: Georgiev
authors: Nina
authors: N
authors: Gotcheva
authors: Lieven
authors: L
authors: Annemans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005060:Europe; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000379:methods; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D055815:Young Adult