Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

Smedt, Delphine De; Annemans, Lieven; Backer, Guy De; Kotseva, Kornelia; Rydén, Lars; Wood, David; Amouyel, Philippe; Bruthans, Jan; Cífková, Renata; Sutter, Johan De; Долженко, М. М.; Ērglis, Andrejs; Gotcheva, Nina; Gyberg, Viveca; Laucevičius, Aleksandras; Lović, Dragan; Оганов, Р. Г.; Pająk, Andrzej; Pogosova, Nana; Reiner, Željko; Stagmo, Martin; Bacquer, Dirk De

doi:10.1016/j.ijcard.2018.06.104

Cited by 15 publications

(9 citation statements)

References 24 publications

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“…A study assessing the cost-effectiveness of the ESC/EAS guidelines in patients with a history of CVD from EUROASPIRE IV, showed variations among estimated costs of statins and ezetimibe across different countries. In Czech Republic, the estimated costs for simvastatin were €0.04-0.29, which was relatively cheaper compared with Ukraine (€0.21-0.42) [26]. It is also noteworthy that following the expiry of the ezetimibe patent in 2017, cheaper generic versions have since become available in the EU.…”

Section: Discussionmentioning

confidence: 99%

Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

et al. 2021

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Background and aims: Central and Eastern Europe (CEE) is a largely understudied region, despite having the highest cardiovascular disease mortality in Europe. This analysis aimed to assess the proportion of patients in CEE who achieved their LDL-C goals based on individual cardiovascular risk recommended by the 2016 and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines. Methods: The DA VINCI study was a cross-sectional observational study of primary and secondary prevention patients receiving lipid-lowering therapy across Europe between June 2017 and November 2018. Results: In total, 2154 patients were enrolled from the Czech Republic (n = 509), Hungary (n = 319), Poland (n = 460), Romania (n = 259), Slovakia (n = 123) and Ukraine (n = 484). At LDL-C measurement, most patients were on either moderate-or high-intensity statin monotherapy (53% and 32%, respectively). Despite this, only 44% of patients achieved risk-based LDL-C goals recommended by the 2016 ESC/EAS guidelines, ranging from 21% in Ukraine to 50% in Hungary and Romania. Only 24% of patients overall achieved the risk-based LDL-C goals recommended by the 2019 ESC/EAS guidelines, ranging from 11% in Ukraine to 32% in Poland. Conclusions: Among patients receiving lipid-lowering therapy, more than half did not achieve their 2016 LDL-C goals. In one of the first comparative analyses evaluating 2019 risk-based goal attainment among countries in CEE, three-quarters of patients did not meet their 2019 LDL-C goals, highlighting a significant gap between guidelines and clinical practice for lipid management in CEE.

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Section: Discussionmentioning

confidence: 99%

Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

et al. 2021

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“…Despite of the guidelines on CVD prevention developed by the European Society of Cardiology (ESC), two large-scale cross-sectional surveys in European countries revealed that a large proportion of patients with CHD received suboptimal management for CVD risk factors ( Kotseva et al, 2009 ; Kotseva et al, 2016 ; Piepoli et al, 2016 ). Optimizing the management of CVD risk factors in these patients, such as using statins to achieve the LDL-C goals and smoking cessation, was found to be cost-effective ( De Smedt et al, 2012 ; De Smedt et al, 2018 ). Our study also suggested that the CVD risk management at a national level can lead to decrease in the costs of CVD.…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic impact of changing reimbursement criteria for statin treatment among patients with type 2 diabetes mellitus in South Korea

Kim

Choi²,

Kim³

et al. 2022

Front. Pharmacol.

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Aim: Patients with type 2 diabetes mellitus (T2DM) in South Korea can be reimbursed for statins if they have a low-density lipoprotein cholesterol (LDL-C) level of ≥100 mg/dL. We aimed to explore the clinical and economic benefit received by T2DM patients when easing the current criteria for statin treatment by lowering the LDL-C threshold from 100 mg/dL to 70 mg/dL.Methods: We used a static course model with a 5-year period to compare the following two scenarios in T2DM patients with no history of cardiovascular (CV) events: the current criteria covering LDL-C ≥100 mg/dL and the revised criteria covering LDL-C ≥70 mg/dL. The number of target patients was estimated based on previous Korean studies on patients with T2DM. The current mix of treatments used for T2DM and costs involving CV events were estimated using the National Health Insurance Service–National Health Screening Cohort database. The baseline CV event rates and case fatality were estimated using NHIS Customized database, including 50% patients who were prescribed atorvastatin and 100% who were not prescribed statins between 2009 and 2012 among patients with T2DM in the entire Korean population. After propensity score matching, patients with T2DM not prescribed statins were followed up until 2018 to estimate the incidence rates of coronary heart disease (CHD) and stroke. The efficacy of atorvastatin for the primary prevention of CV events in patients with T2DM was derived from a pivotal clinical trial. The outcome measures were the number of CV events prevented after the change in criteria and the consequent cost savings.Results: In South Korea, the current and revised criteria covered 2,434,379 and 3,446,149 patients with T2DM, respectively. The change in criteria resulted in the prevention of 726 CV events and cost savings of US dollars (USD) 5.5 million at the national level and USD 0.0089 per member per month in the fifth year.Conclusion: Easing the reimbursement criteria for statin treatment among patients with T2DM was associated with a reduction in CV events and their related costs; therefore, changing the reimbursement criteria is worth further consideration to mitigate the burden of CV disease.

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“…Considering high-risk patients (≥20%), the ICER was reduced to 29,093€/QALY with decreasing ICERs in higherrisk patients. Patients with higher-risk reductions (≥0.5%) were also associated with lower ICERs [59]. Another study evaluating the cost-effectiveness of enhancing adherence to antihypertension medications indicated that enhancing adherence from 52% (the baseline) to 70% and 80% resulted in a reduced ICER from €76,484 (95% CI €74,807-€78,152) to €75,055 (95% CI €73,490-€76,623) and €73,605 (95% CI €72,180-€75,157), respectively, for each hospitalization for a MACE prevented.…”

Section: Economic Outcomesmentioning

confidence: 95%

Medication Adherence in Cardiovascular Diseases

Pham¹,

Nguyen²,

Tran³

et al. 2023

Novel Pathogenesis and Treatments for Cardiovascular Disease

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Cardiovascular disease is a significant cause of death globally. While effective long-term medications that reduce the risk of morbidity and mortality related to cardiovascular disease are readily available, nonadherence to prescribed medications remains a significant reason for suboptimal management. Consequently, this might lead to increased morbidity and mortality and healthcare costs. Medication nonadherence causes are myriad and complicated, with factors at the patient, healthcare provider, and health system levels. Many clinical trials have investigated interventions to target these factors for improving medication adherence, including improving patient education, testing behavioral interventions, implementing medication reminder tools, reducing medication costs, utilizing social support, utilizing healthcare team members, and simplifying medication dosing regimens. This book chapter describes factors influencing medication adherence and highlights the impact of varying levels of adherence on patients’ clinical and economic outcomes. We also summarize interventions for improving medication adherence in cardiovascular disease.

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Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

Cited by 15 publications

References 24 publications

Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study

Clinical and economic impact of changing reimbursement criteria for statin treatment among patients with type 2 diabetes mellitus in South Korea

Medication Adherence in Cardiovascular Diseases

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