Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardivascular disease management programs

Maru, Shoko, Byrnes, Joshua, Whitty, Jennifer, Carrington, Melinda J., Stewart, Simon and Scuffham, Paul A. (2015) Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardivascular disease management programs. European Journal of Cardiovascular Nursing, 14 1: 26-33. doi:10.1177/1474515114536093


Author Maru, Shoko
Byrnes, Joshua
Whitty, Jennifer
Carrington, Melinda J.
Stewart, Simon
Scuffham, Paul A.
Title Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardivascular disease management programs
Journal name European Journal of Cardiovascular Nursing   Check publisher's open access policy
ISSN 1474-5151
1873-1953
Publication date 2015-02
Sub-type Article (original research)
DOI 10.1177/1474515114536093
Open Access Status
Volume 14
Issue 1
Start page 26
End page 33
Total pages 8
Place of publication London, United Kingdom
Publisher Sage Publications
Collection year 2016
Language eng
Formatted abstract
Background: The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality.

Methods: Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included.

Results: Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years’ duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), ‘decision analytic models’ (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant.

Conclusion: The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs.
Keyword Cardiovascular disease
Disease management
Cost effectiveness
Economic evaluation
Markov model
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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Created: Mon, 16 Mar 2015, 12:57:33 EST by Charna Kovacevic on behalf of School of Pharmacy