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Relative cost effectiveness of the SPHERE intervention in selected patient subgroups with existing coronary heart

Paddy Gillespie1, Eamon O'Shea, Andrew W Murphy

  • 1School of Business and Economics, National University of Ireland, Galway, Ireland. paddy.gillespie@nuigalway.ie

The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care
|May 4, 2011
PubMed

Insights

This study found that a secondary prevention intervention for coronary heart disease patients likely saves costs and improves quality-adjusted life years (QALYs). Targeting specific patient subgroups was not statistically supported, but may be considered if budget constraints exist.

Area of Science:

  • Health Economics
  • Cardiovascular Disease Management
  • Public Health Policy

Background:

  • Coronary heart disease (CHD) patient populations exhibit heterogeneity, potentially influencing treatment cost-effectiveness.
  • Budget constraints necessitate evaluating targeted resource allocation for secondary prevention interventions in specific CHD subgroups.

Purpose of the Study:

  • To compare the cost-effectiveness of a secondary prevention intervention for a combined CHD patient population versus three subgroups: elderly (>70 years), those with complex diagnoses (MI, CABG, PTCA), and diabetic patients.
  • To inform resource allocation decisions under budget constraints by analyzing intervention cost-effectiveness across different CHD patient profiles.

Main Methods:

  • A probabilistic model was employed to integrate within-trial and beyond-trial impacts of the SPHERE Intervention against usual care.
  • Lifetime healthcare costs and quality-adjusted life years (QALYs) were estimated for both strategies.
  • Cost-effectiveness was analyzed for the general population and three specific subgroups: patients over 70, patients with diagnoses beyond angina, and patients with diabetes.

Main Results:

  • The SPHERE Intervention demonstrated mean cost savings and QALY gains compared to the control group across all analyses, though statistical significance was not achieved.
  • The probability of the intervention being cost-effective exceeded 85% across various cost-effectiveness thresholds for all patient groups.
  • No strong statistical evidence supported targeting specific subgroups over the general population.

Conclusions:

  • The secondary prevention intervention is likely cost-effective for the general CHD population and specific subgroups.
  • While targeting specific subgroups lacks compelling statistical support, a tentative priority ranking is possible for resource allocation under affordability constraints.
  • Further consideration of subgroup analysis may be warranted if budget limitations are a primary concern in CHD secondary prevention.

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