Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease: Results from the EUROASPIRE IV survey

Research output: Contribution to journalArticle


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.


  • Delphine De Smedt
  • Lieven Annemans
  • Guy De Backer
  • Kornelia Kotseva
  • Lars Rydèn
  • David Wood
  • Philippe Amouyel
  • Jan Bruthans
  • Renata Cifkova
  • Johan De Sutter
  • Marina Dolzhenko
  • Andrejs Erglis
  • Nina Gotcheva
  • Viveca Gyberg
  • Aleksandras Laucevicius
  • Dragan Lovic
  • Rafael Oganov
  • Andrzej Pajak
  • Nana Pogosova
  • Željko Reiner
  • And 2 others
  • Martin Stagmo
  • Dirk De Bacquer
External organisations
  • Ghent University
  • Imperial College London
  • Karolinska Institutet
  • University of Lille
  • Charles University in Prague
  • University of Latvia
  • Vilnius University
  • Ministry of Health of Russian Federation
  • Federal State Institution National Research Center for Preventive Medicine, Russia
  • Skåne University Hospital
  • Thomayer Hospital
  • Shupyk National Medical Academy of Postgraduate Education
  • Riga Eastern Clinical University Hospital
  • National Cardiology Hospital, Sofia
  • Vilnius University Hospital
  • Clinic for internal disease Intermedica, Nis
  • Jagellonian University
  • University Hospital Centre Zagreb
  • University of Zagreb
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • Coronary heart disease, Cost-effectiveness, EUROASPIRE, Guidelines, Secondary prevention
Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - 2018
Publication categoryResearch
Externally publishedYes