The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Gillespie, Paddy; O’Shea, Eamon; Murphy, Andrew W.; Byrne, Mary; Byrne, Molly; Smith, Susan M; Cupples, Margaret

doi:10.1017/s0266462310000358

Cited by 22 publications

(64 citation statements)

References 22 publications

(29 reference statements)

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“…[285][286][287][288][289][290][291][292][293][294] Five papers [285][286][287][288][289] looked specifically at trying to alter patients' behaviour regarding the amount of exercise they took, their diet and other risk factors (e.g. smoking).…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

“…The role of the GP in giving advice concerning lifestyle risks was considered specifically in two papers. 293,294 The first of these examined the use of 'pop-up' reminders on practice computers to improve GPs' awareness of patients with CVD risk factors. The 'nudge' screen would prompt the GP to offer advice and give information about lifestyle risk factors for the patient.…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

“…294 Another trial, examining motivational interviewing and care plans provided by practitioners, found that they did not lead to benefits in terms of blood pressure, cholesterol or health-related quality of life, although it found that there was a reduction in the number of hospital admissions. 293 Studies that examined the effectiveness of clinics where practice nurses monitored lipid levels, blood pressure, medication use and other risk factors such as diet, exercise and smoking suggest that these led to improvements in some aspects of secondary prevention except for smoking cessation and exercise levels. However, what small improvements there were may be misleading, as they relied on patients self-reporting.…”

Section: Effectiveness Of Health Improvement Activities Undertaken Inmentioning

confidence: 99%

See 2 more Smart Citations

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

Section: Effectiveness Of Health Improvement Activities Undertaken Inmentioning

confidence: 99%

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The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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“…This reflects differences between the tax-funded National Health System and a mixed public/private system with user fees for primary care in the two jurisdictions respectively. Previous work has documented important differences in secondary prevention prescribing [41] and cost-effectiveness of secondary prevention in these two jurisdictions [42]. Comparison of trends in the North and the Republic of Ireland is therefore potentially instructive.…”

Section: Comparisons With Recent Trends In Northern Irelandmentioning

confidence: 99%

Modelling Coronary Heart Disease Mortality declines in the Republic of Ireland, 1985–2006

Kabir

Perry

Critchley

et al. 2013

International Journal of Cardiology

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Background: Consistent declines in coronary heart disease (CHD) death rates have been previously observed in Ireland since1985. Aims & Methods: To use the previously validated Irish IMPACT CHD mortality model to further examine the subsequent CHD mortality falls from 1985 through to 2006, and to determine the contribution of risk factor changes and "evidence based" treatments to this decline by age and gender. Results: CHD mortality rates fell by 68% in men (63% in 65-84 years) and by 69% in women (66% in 65-84 years). This resulted in approximately 6450 fewer CHD deaths than if mortality rates had not changed. Overall, approximately 40% (38% in men; 45% in women) of the CHD mortality decline could be attributed to improvements in treatment uptake, particularly secondary prevention (12%), angina (9%), and heart failure therapies (8%). Approximately 48% of the CHD mortality decline was attributable to risk factor improvements (54% in men; 37% in women); the biggest contributions came from falls in population systolic pressure (28%), cholesterol (24%), and physical inactivity levels (10%). Negative trends in diabetes and obesity levels generated an estimated 17% additional CHD deaths. The largest benefits from improvements in risk factors were seen in men aged 25-64 years, while the greatest treatment benefits occurred in women aged 65-84 years. The model explained approximately 88% of the observed mortality declines. Conclusion: Falls in CHD mortality have continued in both sexes in Ireland, but with notable gender and age differences. The continued increase in diabetes and obesity levels is particularly worrying.

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“…Decision analytical modelling provides a framework for undertaking such analysis [3] and has been applied widely in the evaluation of secondary cardiovascular prevention [4]. In a recent study, we examined the cost effectiveness of the secondary prevention of heart disease in general practice (SPHERE) intervention relative to existing primary care in both health systems on the island of Ireland [5]. The Republic of Ireland has a mixed health care system, with free access to primary care services for those judged less able to pay and those aged 70 years and over (32% of population registered in 2005 [6]).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Heterogeneity exists within the patient population with coronary heart disease and the cost effectiveness of treatment may vary across subgroups within the overall population. This study compares the cost effectiveness of a secondary prevention intervention for a combined patient population relative to three selected subgroups: patients aged over 70 years; patients with a diagnosis other than angina only (that is, patients with a history of myocardial infarction, coronary artery bypass graft and/or percutaneous transluminal coronary angioplasty); and patients with diabetes. The results for the general population have been published elsewhere, but ongoing budget constraints require consideration of the appropriateness of targeting resources to patient subgroups. We adopt a probabilistic model to combine within trial and beyond trial impacts of treatment to estimate the lifetime health care costs and quality-adjusted life years of two primary care-based secondary prevention strategies: SPHERE Intervention--tailored practice and patient care plans and Control--standardised usual care. In all cases, the intervention was associated with mean cost savings and mean QALYs gains, when compared to the control, though statistical significance was never achieved. However, the probability of the intervention being cost effective was higher than 85% in all analyses across a range of potential cost-effectiveness threshold values. There is no compelling statistical evidence to support the targeting of specific subgroups across the general population. However, if affordability constraints are binding, the results do allow a tentative ranking of priorities based on the probabilistic subgroup analysis.

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The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Cited by 22 publications

References 22 publications

The organisation and delivery of health improvement in general practice and primary care: a scoping study

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Modelling Coronary Heart Disease Mortality declines in the Republic of Ireland, 1985–2006

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

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