Hostname: page-component-5d59c44645-k78ct Total loading time: 0 Render date: 2024-03-02T02:14:14.734Z Has data issue: false hasContentIssue false

The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Published online by Cambridge University Press:  29 June 2010

Paddy Gillespie
Affiliation:
National University of Ireland, Galway
Eamon O'Shea
Affiliation:
National University of Ireland, Galway
Andrew W. Murphy
Affiliation:
National University of Ireland, Galway
Mary C. Byrne
Affiliation:
National University of Ireland, Galway
Molly Byrne
Affiliation:
National University of Ireland, Galway
Susan M. Smith
Affiliation:
Trinity College Dublin
Margaret E. Cupples
Affiliation:
Queen's University Belfast

Abstract

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.

Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.

Results: The intervention strategy resulted in mean cost savings per patient of €512.77 (95 percent confidence interval [CI], −1086.46–91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, −0.0101–0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY.

Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.

Type
ASSESSMENTS
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Barry, M, Tilson, L. Recent developments in pricing and reimbursement of medicines in Ireland. Expert Rev Pharmacoecon Outcomes Res. 2007;7:605611.Google Scholar
2. Brazier, JE, Roberts, J. Estimating a preference-based index from the SF-12. Med Care. 2004;42:851859.Google Scholar
3. Campbell, MK, Elbourne, DR, Altman, DG, et al. CONSORT statement: Extension to cluster randomised trials. BMJ. 2004;328:702708.Google Scholar
4. Central Bank of Ireland. Dublin (www.centralbank.ie). (Accessed June 2008)Google Scholar
5. Central Statistics Office. Dublin (www.cso.ie). (Accessed June 2008)Google Scholar
6. Clark, AM, Hartling, L, Vandermeer, B, McAlister, FA. Meta-analysis: Secondary prevention programs for patients with coronary artery disease. Ann Intern Med. 2005;143:659672.Google Scholar
7. Cupples, ME, Byrne, MC, Smith, SM, Leathem, C, Murphy, AW. Secondary prevention of cardiovascular disease in different primary healthcare systems, with and without pay-for-performance. Heart. 2008;94:15941600.Google Scholar
8. D'Agostino, RB, Russell, M, Huse, DM, et al. Primary and subsequent coronary risk appraisal: New results from The Framingham Study. Am Heart J. 2000;139:272281.Google Scholar
9. De Backer, G, Ambrosioni, E, Borch-Johnsen, K, et al. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2003;24:16011610.Google Scholar
10. Department of Health and Children. The National Heartwatch Programme: Clinical report - March 2003 to December 2005. Dublin; 2006.Google Scholar
11. Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, J, Stoddart, GL. Methods for the economic evaluation of health care programmes. New York: Oxford University Press;2005.Google Scholar
12. Glick, HA, Doshi, JA, Sonnad, SS, Polsky, D. Economic evaluation in clinical trials. New York: Oxford University Press; 2007.Google Scholar
13. Hardin, JW, Hilbe, JM. Generalised estimating equations. London: Chapman and Hall/CRC Press; 2003.Google Scholar
14. Johnston, K, Gray, A, Moher, M, et al. Reporting the cost-effectiveness of interventions with nonsignificant effect differences: Example from the a trial of secondary prevention of heart disease. Int J Technol Assess Health Care. 2003;19:476489.Google Scholar
15. Ketola, E, Laatikainen, T, Vartianinen, E. Evaluating risk for cardiovascular diseases -vain or value? How do different cardiovascular risk scores act in real life. Eur J Public Health. 2010;20:107112.Google Scholar
16. Lacey, EA, Walters, SJ. Continuing inequality: Gender and social class influences on self perceived health after a heart attack. J Epidemiol Community Health. 2003;57:622627.Google Scholar
17. Manca, A, Hawkins, N, Sculpher, M. Estimating mean QALYs in trial based cost effectiveness analysis: The importance of controlling for baseline utility. Health Econ. 2005;14:487496.Google Scholar
18. Murphy, AW, Cupples, ME, Smith, S, et al. Secondary prevention of heart disease in general practice: A cluster randomised controlled trial of tailored practice and patient care plans. BMJ. 2009;339:b4220.Google Scholar
19. Netten, A, Curtis, J. Unit costs of health and social care. Canterbury: Personal Social Services Research Unit. University of Kent; 2006.Google Scholar
20. National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2004. www.nice.org.uk/page.aspx?o=201974 (reference 0515).Google Scholar
21. O'Neill, C, Normand, C, Cupples, M, McKnight, A. Cost effectiveness of personal health education in primary care for people with angina in the Greater Belfast area of Northern Ireland. J Epidemiol Community Health. 1996;50:538540.Google Scholar
22. Raftery, JP, Yao, GL, Murchie, P, Campbell, NC, Ritchie, LD. Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: Follow up of a randomised controlled trial. BMJ. 2005;330:707.Google Scholar
23. Robinson, M, Palmer, S, Sculpher, M, et al. Cost effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: Systematic review and decision-analytical modelling. Health Technol Assess. 2005;9:iii-iv, ix-xi, 1158.Google Scholar
24. Turner, DA, Paul, SK, Stone, M, et al. Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care. Heart. 2008;94:16011606.Google Scholar
25. Ware, JE, Kosinski, M, Keller, SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220233.Google Scholar
Supplementary material: File

Gillespie et al. supplementary material

Tables and figures

Download Gillespie et al. supplementary material(File)
File 224 KB