BACKGROUND: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. METHODS: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). RESULTS: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. CONCLUSION: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.

Cardiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden

Centre for Cardiovascular Prevention 1st Medical Faculty Charles University and Thomayer Hospital Prague Czech Republic

Clinic for Internal Medicine Intermedica Nis Serbia

Clinic of Cardiovascular Diseases of Vilnius University Heart and Vascular Medicine of Vilnius University Hospital Santaros Klinikos Vilnius Lithuania

Department of Cardiology National Heart Hospital Sofia Bulgaria

Department of Cardiology Shupyk's National Medical Academy of Postgraduate Education Kiev Ukraine

Department of Heart Failure and Valve Disease Skane University Hospital Lund Sweden

Department of Internal Medicine Ghent University Belgium

Department of Public Health Ghent University Ghent Belgium

Department of Public Health Ghent University Ghent Belgium; International Centre for Circulatory Health National Heart and Lung Institute Imperial College London UK

Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention National Research Centre for Preventive Medicine Moscow Russia

Institut Pasteur de Lille Université de Lille France

International Centre for Circulatory Health National Heart and Lung Institute Imperial College London UK

Jagiellonian University Medical College Faculty of Health Sciences Department of Epidemiology and Population Studies Kracow Poland

National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation Moscow Russia

University Hospital Centre Zagreb School of Medicine University of Zagreb Zagreb Croatia

University of Latvia Pauls Stradins Clinical University Hospital Riga Latvia

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