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EUROASPIRE III: modelling the clinical and cost-effectiveness of optimizing cardiovascular prevention in patients with established coronary heart disease in Europe


Lieven Annemans Lieven Annemans (Belgium)

Presentation webcast

Presentation slides

List of Authors:
Delphine De Smedt, Lieven Annemans, Guy De Backer, Dirk De Bacquer, Kornelia Kotseva, David Wood.


Introduction and purpose: In the EUROASPIRE III survey it was shown that in patients with established coronary heart disease (CHD) the guidelines on CHD prevention are poorly implemented. The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in 8 EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, UK).

Methods: The individual risk for subsequent cardiovascular events (coronary, cerebrovascular, heart failure) for all patients in the EUROASPIRE III database was estimated based on the published Framingham equations for recurrent events, calibrated for more recent EU observational data in order to adjust for advances in medical management over the last decades. For each patient, the type of suboptimal prevention, if any, was identified, and the effects of tailored intervention (smoking cessation, diet & exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated based on published meta-analyses.
Costs of prevention and savings by avoided events were based on country specific data obtained through the national EUROASPIRE coordinators of the participating countries. Modeling is based on a total of 2196 coronary patients not meeting one or more of the targets . A health care perspective and a time horizon of 10 years were applied. Costs and effects were discounted and a willingness to pay threshold of 30,000€/quality adjusted life year (QALY) was used. Robustness of the results was validated by one-way and multi-way sensitivity analyses.

Results: overall, the cost-effectiveness analyses for the 8 countries showed mainly favorable results with an average incremental cost effectiveness ratio (ICER) of € 16,000 per QALY. The relative risk reductions for intensified blood pressure lowering therapy and cholesterol lowering therapy were shown to have the greatest influence on the ICERs. Only in the minority of patients at 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 59% of the patients who were not at goal for cholesterol, were yet close to target; hence the room for improvement is rather limited.

Discussion: 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.




Clinical Registry Highlight I - Risk and treatment reality

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.