The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands
Received 12 August 2008; accepted 12 January 2009.
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 465000 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 15000 € per quality-adjusted life year gained. In the age categories 70–79 years and 80 years or above, an additional 600000 and 450000 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 20800 and 32300 €, 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.
aCentre for Prevention and Health Services Research
bExpertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Correspondence to Dr Monique W.M. Verschuren, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, PO Box 1, 3720 BA Bilthoven, The Netherlands Tel: +31 30 274 3508; fax: +31 30 274 4407;
ABSTRACT