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

Miqdad Asaria; Simon Mark Walker; Stephen John Palmer; Christopher Gale; Anoop D Shah; Keith Abrams; Michael Crowther; Andrea Manca; Adam Timmis; Harry Hemingway; Mark Sculpher

doi:10.1136/heartjnl-2015-308850

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

Miqdad Asaria, Simon Mark Walker, Stephen John Palmer, Christopher Gale, Anoop D Shah, Keith Abrams, Michael Crowther, Andrea Manca, Adam Timmis, Harry Hemingway, Mark Sculpher

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	Heart
DOIs	https://doi.org/10.1136/heartjnl-2015-308850
Publication status	Published - 10 Feb 2016

Bibliographical note

This content is made available by the publisher under a Creative Commons Attribution Licence. This means that a user may copy, distribute and display the resource providing that they give credit. Users must adhere to the terms of the licence.

Access to Document

10.1136/heartjnl-2015-308850

Heart-2016-Asaria-heartjnl-2015-308850
This content is made available by the publisher under a Creative Commons Attribution Licence. This means that a user may copy, distribute and display the resource providing that they give credit. Users must adhere to the terms of the licence.
Final published version, 677 KB

NIHR Programme Grant: Improving the quality of care for angina and heart attack
Sculpher, M. (Principal investigator), Asaria, M. (Co-investigator), Manca, A. (Co-investigator), Palmer, S. J. (Co-investigator) & Walker, S. M. (Co-investigator)
1/08/12 → 31/07/14
Project: Research project (funded) › Research

Cite this

@article{46bdcee2df394d78b0dbc76972f67b6b,

title = "Using electronic health records to predict costs and outcomes in stable coronary artery disease",

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.",

author = "Miqdad Asaria and Walker, {Simon Mark} and Palmer, {Stephen John} and Christopher Gale and Shah, {Anoop D} and Keith Abrams and Michael Crowther and Andrea Manca and Adam Timmis and Harry Hemingway and Mark Sculpher",

note = "This content is made available by the publisher under a Creative Commons Attribution Licence. This means that a user may copy, distribute and display the resource providing that they give credit. Users must adhere to the terms of the licence. ",

year = "2016",

month = feb,

day = "10",

doi = "10.1136/heartjnl-2015-308850",

language = "English",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ",

}

TY - JOUR

T1 - Using electronic health records to predict costs and outcomes in stable coronary artery disease

AU - Asaria, Miqdad

AU - Walker, Simon Mark

AU - Palmer, Stephen John

AU - Gale, Christopher

AU - Shah, Anoop D

AU - Abrams, Keith

AU - Crowther, Michael

AU - Manca, Andrea

AU - Timmis, Adam

AU - Hemingway, Harry

AU - Sculpher, Mark

N1 - This content is made available by the publisher under a Creative Commons Attribution Licence. This means that a user may copy, distribute and display the resource providing that they give credit. Users must adhere to the terms of the licence.

PY - 2016/2/10

Y1 - 2016/2/10

N2 - 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.

AB - 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.

U2 - 10.1136/heartjnl-2015-308850

DO - 10.1136/heartjnl-2015-308850

M3 - Article

C2 - 26864674

SN - 1355-6037

JO - Heart

JF - Heart

ER -

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

Abstract

Bibliographical note

Access to Document

Projects

NIHR Programme Grant: Improving the quality of care for angina and heart attack

Cite this