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Heart. 2016 May 15;102(10):755-62. doi: 10.1136/heartjnl-2015-308850. Epub 2016 Feb 10.

Using electronic health records to predict costs and outcomes in stable coronary artery disease.

Author information

1
Centre for Health Economics, University of York, York, UK.
2
Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
3
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College, London, UK.
4
Department of Health Sciences, University of Leicester, Leicester, UK.
5
NIHR Biomedical Research Unit, Barts and the London NHS Trust, London, UK.

Abstract

OBJECTIVES:

To use electronic health records (EHR) to predict lifetime costs and health outcomes of patients with stable coronary artery disease (stable-CAD) stratified by their risk of future cardiovascular events, and to evaluate the cost-effectiveness of treatments targeted at these populations.

METHODS:

The analysis was based on 94 966 patients with stable-CAD in England between 2001 and 2010, identified in four prospectively collected, linked EHR sources. Markov modelling was used to estimate lifetime costs and quality-adjusted life years (QALYs) stratified by baseline cardiovascular risk.

RESULTS:

For the lowest risk tenth of patients with stable-CAD, predicted discounted remaining lifetime healthcare costs and QALYs were £62 210 (95% CI £33 724 to £90 043) and 12.0 (95% CI 11.5 to 12.5) years, respectively. For the highest risk tenth of the population, the equivalent costs and QALYs were £35 549 (95% CI £31 679 to £39 615) and 2.9 (95% CI 2.6 to 3.1) years, respectively. A new treatment with a hazard reduction of 20% for myocardial infarction, stroke and cardiovascular disease death and no side-effects would be cost-effective if priced below £72 per year for the lowest risk patients and £646 per year for the highest risk patients.

CONCLUSIONS:

Existing EHRs may be used to estimate lifetime healthcare costs and outcomes of patients with stable-CAD. The stable-CAD model developed in this study lends itself to informing decisions about commissioning, pricing and reimbursement. At current prices, to be cost-effective some established as well as future stable-CAD treatments may require stratification by patient risk.

PMID:
26864674
PMCID:
PMC4849559
DOI:
10.1136/heartjnl-2015-308850
[Indexed for MEDLINE]
Free PMC Article

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