The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands

Background A new Dutch guideline for cardiovascular disease management substantially extends the number of individuals for whom treatment with statins and/or anti hypertensive agents is recommended. We estimated the cost-effectiveness of implementing the new guideline at the national level. Methods First, the number of currently untreated individuals who would become eligible for cholesterol-lowering or anti hypertensive treatment under the new guideline was estimated using data from a recent population study. Cost-effectiveness of treating this group of patients was then assessed using a mathematical model. Results Implementing the guideline in the age category 30-69 years would lead to an additional 465000 individuals requiring treatment. Over a period of 20 years, the cumulative incidence of acute myocardial infarction in the whole population would drop by 3.0%, that of stroke by 3.9%, and all-cause mortality would drop by 0.9%. The lifetime cost-effectiveness ratio was calculated to be 15000 E per quality-adjusted life year gained. In the age categories 70-79 years and 80 years or above, an additional 600000 and 450000 persons, respectively, would need to be treated, resulting in corresponding reductions in cumulative incidences of 14 and 18% (acute myocardial infarction), 17 and 22% (stroke), and 1.2 and 0.6% (all-cause morality) with cost-effectiveness ratios of 20 800 and 32 300 E, respectively, per quality-adjusted life year. Conclusion Complete implementation of the new guideline would lead to a considerable increase in the number of individuals requiring treatment. This would be cost-effective up to the age of 70 years. Eur J Cardiovasc Prev Rehabil 16:371-376 (C) 2009 The European Society of Cardiology