title: Cost effectiveness of a systematic guidelines-based approach to the prevention and management of vascular disease in a primary care setting.
abstract: BACKGROUND
  In Ontario, Canada, the Comprehensive Vascular Disease Prevention and Management Initiative (CVDPMI) was undertaken to improve the vascular health in communities. The CVDPMI significantly improved cardiovascular (CV) risk factor profiles from baseline to follow-up visits including the 10 year Framingham Risk Score (FRS). Although the CVDPMI improved CV risk, the economic value of this program had not been evaluated.
  
  
  METHODS
  We examined the cost effectiveness of the CVDPMI program compared to no CVDPMI program in adult patients identified at risk for an initial or subsequent vascular event in a primary care setting. A one year and a ten year cost effectiveness analyses were conducted. To determine the uncertainty around the cost per life year gained ratio, a non-parametric bootstrap analysis was conducted.
  
  
  RESULTS
  The overall population base case analysis at one year resulted in a cost per CV event avoided of $70,423. FRS subgroup analyses showed the high risk cohort (FRS >20%) had an incremental cost effectiveness ratio (ICER) that was dominant. In the moderate risk subgroup (FRS 10%-20%) the ICER was $47,439 per CV event avoided and the low risk subgroup (FRS <10%) showed a highly cost ineffective result of greater than $5 million per CV event avoided. The ten year analysis resulted in a dominant ICER.
  
  
  CONCLUSIONS
  At one year, the CVDPMI program is economically acceptable for patients at moderate to high risk for CV events. The CVDPMI results in increased life expectancy at an incremental cost saving to the healthcare system over a ten year period.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. Electronic address: kambojl@mcmaster.ca.
authors.forename: Laveena
authors.initials: L
authors.lastname: Kamboj
authors.affiliation: University Health Network, 550 University Ave, Toronto, ON M5G 2A2, Canada. Electronic address: paul.oh@uhn.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. Electronic address: levinem@mcmaster.ca.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levine
authors.affiliation: Peterborough Regional Nephrology Associates, 239 Charlotte St, Peterborough, ON K9J 2V1, Canada. Electronic address: srinu.kammila@prna.net.
authors.forename: Srinu
authors.initials: S
authors.lastname: Kammila
authors.affiliation: Primary Health Care Services of Peterborough, 150 King Street, Peterborough, ON K9J 2R9, Canada. Electronic address: bill.casey@peterboroughfht.com.
authors.forename: William
authors.initials: W
authors.lastname: Casey
authors.affiliation: Primary Health Care Services of Peterborough, 150 King Street, Peterborough, ON K9J 2R9, Canada. Electronic address: don.harterre@peterboroughfht.com.
authors.forename: Don
authors.initials: D
authors.lastname: Harterre
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. Electronic address: goereer@mcmaster.ca.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
mesh_terms: D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009017:Morbidity / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics* / Q000592:standards; D011379:Prognosis; D014652:Vascular Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy*
keywords: Cost effectiveness analysis; Prevention; Primary care; Vascular disease