The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands

Abstract

Background

A new Dutch guideline for cardiovascular disease management substantially extends the number of individuals for whom treatment with statins and/or antihypertensive agents is recommended. We estimated the cost-effectiveness of implementing the new guideline at the national level.

Methods

First, the number of currently untreated individuals who would become eligible for cholesterol-lowering or antihypertensive treatment under the new guideline was estimated using data from a recent population study. Cost-effectiveness of treating this group of patients was then assessed using a mathematical model.

Results

Implementing the guideline in the age category 30-69 years would lead to an additional 465 000 individuals requiring treatment. Over a period of 20 years, the cumulative incidence of acute myocardial infarction in the whole population would drop by 3.0%, that of stroke by 3.9%, and all-cause mortality would drop by 0.9%. The lifetime cost-effectiveness ratio was calculated to be 15 000 € per quality-adjusted life year gained. In the age categories 70-79 years and 80 years or above, an additional 600 000 and 450 000 persons, respectively, would need to be treated, resulting in corresponding reductions in cumulative incidences of 14 and 18% (acute myocardial infarction), 17 and 22% (stroke), and 1.2 and 0.6% (all-cause mortality) with cost-effectiveness ratios of 20 800 and 32 300 €, respectively, per quality-adjusted life year.

Conclusion

Complete implementation of the new guideline would lead to a considerable increase in the number of individuals requiring treatment. This would be cost-effective up to the age of 70 years.

Keywords

cardiovascular disease cardiovascular risk cost-benefit analysis guideline hypercholesterolemia hypertension primary prevention Systematic Coronary Risk Evaluation

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