title: Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease.
abstract: BACKGROUND
  We have shown that a case-based training programme for general practitioners, aimed to implement evidence-based care of patients at very high risk of coronary death, was associated with decreased mortality. In the present study we assessed long-term cost-effectiveness of this programme.
  
  
  METHODS
  Registry-based long-term cost-effectiveness analysis on a clinical trial.
  
  
  METHODS
  Costs of the programme, health care, drugs and added years of life were included. Costs were adjusted to 2012 level and discounted by 3%. Life-years gained were estimated as the difference between the survival curves of the trial. The effectiveness measure, quality adjusted life-years (QALYs), was constructed by multiplying each life-year with a quality of life weight corresponding to the health status of that year. QALYs were also discounted by 3%. Incremental cost-effectiveness ratio (ICER) was estimated as the incremental cost per QALY gained.
  
  
  RESULTS
  The number of undiscounted life-years gained was 365 days in the intervention group as compared to control (p = 0.02). The number of discounted QALYs gained was 0.66. The net increase in total costs was estimated as 17,862 € when costs of added years of life were included and 4621 € exclusive of these costs. This implied an ICER of 27,063 € per gained QALY. This ICER is well below commonly used threshold values of the societal willingness to pay for a QALY.
  
  
  CONCLUSIONS
  The results show that a case-based training programme of general practitioners is a cost-effective way to save years of life in patients with very high risk of coronary death.
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Groot-Jensen
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden anna.kiessling@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Kiessling
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Zethraeus
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Björnstedt-Bennermo
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksson
mesh_terms: D002317:Cardiovascular Agents / Q000191:economics; D003324:Coronary Artery Disease / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education*; D019057:Quality-Adjusted Life Years; D013548:Sweden
chemical_list: D002317:Cardiovascular Agents
keywords: Coronary disease; case-based training; cost analysis; quality of health care; quality-adjusted life years; secondary prevention; time trade off method