Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.
BACKGROUND
The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality.


METHODS
Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included.


RESULTS
Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant.


CONCLUSIONS
The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs.
Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia.
Shoko
S
Maru
Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia.
Joshua
J
Byrnes
Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia.
Jennifer A
JA
Whitty
NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Melinda J
MJ
Carrington
NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Simon
S
Stewart
Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia p.scuffham@griffith.edu.au.
Paul A
PA
Scuffham
D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D017063:Outcome Assessment, Health Care / Q000191:economics; D010346:Patient Care Management / Q000191:economics* / Q000379:methods; D014481:United States
Cardiovascular disease; Markov model; cost effectiveness; disease management; economic evaluation