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Relative cost effectiveness of the SPHERE intervention in selected patient subgroups with existing coronary heart disease

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Abstract

Heterogeneity exists within the patient population with coronary heart disease and the cost effectiveness of treatment may vary across subgroups within the overall population. This study compares the cost effectiveness of a secondary prevention intervention for a combined patient population relative to three selected subgroups: patients aged over 70 years; patients with a diagnosis other than angina only (that is, patients with a history of myocardial infarction, coronary artery bypass graft and/or percutaneous transluminal coronary angioplasty); and patients with diabetes. The results for the general population have been published elsewhere, but ongoing budget constraints require consideration of the appropriateness of targeting resources to patient subgroups. We adopt a probabilistic model to combine within trial and beyond trial impacts of treatment to estimate the lifetime health care costs and quality-adjusted life years of two primary care-based secondary prevention strategies: SPHERE Intervention—tailored practice and patient care plans and Control—standardised usual care. In all cases, the intervention was associated with mean cost savings and mean QALYs gains, when compared to the control, though statistical significance was never achieved. However, the probability of the intervention being cost effective was higher than 85% in all analyses across a range of potential cost-effectiveness threshold values. There is no compelling statistical evidence to support the targeting of specific subgroups across the general population. However, if affordability constraints are binding, the results do allow a tentative ranking of priorities based on the probabilistic subgroup analysis.

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Acknowledgments

We would like to thank the other members of the SPHERE study team including C. Leathem, A. Houlihan, M. O.’Malley, V. Spillane, H. Grealish and P. Ryan (research nurses); M. Corrigan, M. D’Eath and J. Wilson (qualitative researchers); and A. Kelly, J. Newell and M. Donnelly (statistical and policy advisers). We would also like to thank the patients and practitioners who participated in the study. This study was funded by the Health Research Board and Irish Heart Foundation. The funders had no part in the design of the study; the collection, analysis and interpretation of the data; the writing of the report; and the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. School of Business and Economics, National University of Ireland, Galway, Ireland

    Paddy Gillespie & Eamon O’Shea

  2. Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland

    Paddy Gillespie & Eamon O’Shea

  3. Department of General Practice, National University of Ireland, Galway, Ireland

    Andrew W. Murphy & Mary C. Byrne

  4. Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland

    Susan M. Smith

  5. School of Psychology, National University of Ireland, Galway, Ireland

    Molly Byrne

  6. Department of General Practice, Queen’s University Belfast, Belfast, Northern Ireland, UK

    Margaret E. Cupples

Authors
  1. Paddy Gillespie
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  2. Eamon O’Shea
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  3. Andrew W. Murphy
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  4. Susan M. Smith
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  5. Mary C. Byrne
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  6. Molly Byrne
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  7. Margaret E. Cupples
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Correspondence to Paddy Gillespie.

Appendix: model input parameter data

Appendix: model input parameter data

See Tables (5, 6, 7, 8) and Fig. (3a, b, c).

Table 5  
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Table 6  
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Table 7  
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Table 8  
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Fig. 3
figure 3

a Base-case analysis versus ‘exclude patients with angina only’; b Base-case analysis versus ‘patients over 70’; c Base-case analysis versus ‘patients with diabetes’

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Gillespie, P., O’Shea, E., Murphy, A.W. et al. Relative cost effectiveness of the SPHERE intervention in selected patient subgroups with existing coronary heart disease. Eur J Health Econ 13, 429–443 (2012). https://doi.org/10.1007/s10198-011-0314-2

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  • DOI: https://doi.org/10.1007/s10198-011-0314-2

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