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

Miqdad Asaria (), Simon Walker, Stephen Palmer, Chris P Gale, Anoop D Shah, Keith R Abrams, Michael Crowther, Andrea Manca, Adam Timmis, Harry Hemingway and Mark Sculpher

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

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.

JEL-codes: E6 (search for similar items in EconPapers)
Pages: 8 pages
Date: 2016-05-01
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Published in Heart, 1, May, 2016, 102(10), pp. 755 – 762. ISSN: 1355-6037

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