Cost-effectiveness of a European preventive cardiology programme in primary care: a Markov modelling approach

OBJECTIVE To investigate the longer-term cost-effectiveness of a nurse-coordinated preventive cardiology programme for primary prevention of cardiovascular disease (CVD) compared to routine practice from a health service perspective. DESIGN A matched, paired cluster-randomised controlled trial. SETTING Six pairs of general practices in six countries. PARTICIPANTS 1019 patients were randomised to the EUROACTION intervention programme and 1005 patients to usual care (UC) and who completed the 1-year follow-up. OUTCOME MEASURES Evidence on health outcomes and costs was based on patient-level data from the study, which had a 1-year follow-up period. Future risk of CVD events was modelled, using published risk models based on patient characteristics. An individual-level Markov model for each patient was used to extrapolate beyond the end of the trial, which was populated with data from published sources. We used an 11-year time horizon and investigated the impact on the cost-effectiveness of varying the duration of the effect of the intervention beyond the end of the trial. Results are expressed as incremental cost per quality-adjusted life-year gained. RESULTS Unadjusted results found the intervention to be more costly and also more effective than UC. However, after adjusting for differences in age, gender, country and baseline risk factors, the intervention was dominated by UC, but this analysis was not able to take into account the lifestyle changes in terms of diet and physical activity. CONCLUSIONS Although the EUROACTION study achieved healthier lifestyle changes and improvements in management of blood pressure and lipids for patients at high risk of CVD, compared to UC, it was not possible to show, using available risk equations which do not incorporate diet and physical activity, that the intervention reduced longer-term cardiovascular risk cost-effectively. Whether or not an intervention such as that offered by EUROACTION is cost-effective requires a longer-term trial with major cardiovascular events as the outcome. TRIAL REGISTRATION NUMBER ISRCTN 71715857.