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


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.

Copyright © Cambridge University Press 2010

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