Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

Delphine De Smedt, Lieven Annemans, Guy De Backer, Kornelia Kotseva, Lars Rydèn, David Wood, Philippe Amouyel, Jan Bruthans, Renata Cifkova, Johan De Sutter, Marina Dolzhenko, Andrejs Erglis, Nina Gotcheva, Viveca Gyberg, Aleksandras Laucevicius, Dragan Lovic, Rafael Oganov, Andrzej Pajak, Nana Pogosova, Željko ReinerMartin Stagmo, Dirk De Bacquer

Research output: Contribution to journalArticle

6 Citations (Scopus)


BACKGROUND: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease.

METHODS: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER).

RESULTS: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY.

CONCLUSION: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.

Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - 1 Dec 2018

Bibliographical note

Copyright © 2018 Elsevier B.V. All rights reserved.


  • Coronary heart disease
  • Cost-effectiveness
  • Guidelines
  • Secondary prevention

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