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Saturday, 22 October 2005
23

LOW IMPACT OF SECONDARY CARDIOVASCULAR EVENTS ON HEALTH STATUS

Henk F. Van Stel, PhD, UMC Utrecht, Utrecht, Netherlands, E. Buskens, University Medical Center Utrecht, Utrecht, Netherlands, Jan J.V. Busschbach, PhD, Erasmus Medical Center, Rotterdam, Netherlands, and M.G. Myriam Hunink, PhD, MD, Erasmus Medical Center, Rotterdam, Netherlands.

PURPOSE: Reliable estimates regarding the impact of secondary cardiovascular events on health status in patients treated for cardiovascular disease is unavailable. Precise estimates are, however, necessary to reduce uncertainty about actual impact, particularly for health economic modelling. METHODS: We gathered individual patient data on health status (EQ5D) and secondary cardiovascular events (death, myocardial infarction (MI), cerebrovascular accidents (CVA), amputation, extracranial bleeding, re-interventions) during 12 to 36 months follow-up from 5 completed clinical trials comparing interventions aimed at revascularisation for patients with cardiovascular disease. Included were three trials on patients with coronary heart disease (CHD, total n=1405), and two trials on patients with peripheral artery disease (PAD, total n=1353). Only the first secondary event of a patient was considered. We performed change point analysis by re-arranging measurements on the time-line, relative to the time of the event. Then a random effects model was fitted using S-plus and R on all utility scores for patients with events, correcting for time, gender, and age. Impact of an event corresponds to the change in intercept. RESULTS: After revascularisation patients without secondary events improved to 0.86 in CHD and 0.63 in PAD. 48.3% of the EQ-5D scores before, and 33.4% of scores after the event were missing. Females had lower pre-event EQ-5D scores than males on all events: -0.04 for occlusion to -0.28 for amputation. Patients with an event had markedly lower EQ-5D scores before the event than patients without event, especially in amputation, occlusion and CVA. Impact of secondary events was -0.04 (p=0.3, n=68) for CVA, +0.07 for MI (p=0.3, n=117), +0.01 for occlusion (p=0.5, n=263), +0.06 for extracranial bleeding (p=0.11, n=89), +0.04 for re-interventions (p=0.005, n=789) and +0.23 for amputation (p=0.004, n=28). Possibly, selective dropout of more severe patients explains some of these unexpected effects. However, we found no difference in days in hospital (a proxy for severity) after the primary intervention between patients with or without secondary event. CONCLUSIONS: The impact of a secondary event in patients with CHD or PAD is appears lower than expected. This effect may largely be explained because patients with an event already have a lowered health status before the event. This needs to be taken into account in long-term economic modelling.

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