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Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
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Identifying Outcome Measures for Coronary Artery Disease Value-Based Contracting Using the Delphi Method.

Lynn M Neilson1, Elizabeth C S Swart2, Chester B Good2,3

  • 1Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA. neilsonl@upmc.edu.

Cardiology and Therapy
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Summary

Value-based contracts for coronary artery disease (CAD) medications should prioritize preventing heart attacks. This outcome was most meaningful to stakeholders in a Delphi study, supporting its use in pharmaceutical contracting.

Keywords:
AntiplateletsCoronary artery disease (CAD)Delphi methodDrug costsOutcome measuresPharmaceuticalsValue-based contracting (VBC)

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Area of Science:

  • Health Economics
  • Pharmaceutical Policy
  • Cardiovascular Medicine

Background:

  • Value-based contracts (VBCs) align drug payments with performance metrics to enhance medication value and reduce costs.
  • VBCs facilitate risk-sharing between payers and pharmaceutical manufacturers.
  • Identifying meaningful outcomes is crucial for effective VBCs in coronary artery disease (CAD).

Purpose of the Study:

  • To identify stakeholder-valued outcome measures for CAD medication VBCs.
  • To inform the development of VBCs for CAD treatments.
  • To assess the relevance of clinical indicators for CAD VBCs.

Main Methods:

  • A modified Delphi survey was used to gather expert opinions from diverse stakeholders.
  • Participants included patients, physicians, payers, and pharmaceutical representatives.
  • Consensus was defined as ≥75% agreement on outcome importance or selection as most meaningful.

Main Results:

  • Eleven of 13 CAD-associated clinical indicators reached consensus for importance.
  • "Preventing heart attacks" was the most meaningful outcome (80% agreement).
  • "Preventing death" was the second most meaningful outcome (76% agreement).

Conclusions:

  • Myocardial infarction events are a validated and meaningful outcome measure for CAD VBCs.
  • Stakeholder input is essential for designing effective VBCs.
  • The findings support the use of "preventing heart attacks" as a key metric in CAD pharmaceutical contracts.