COST-EFFECTIVENESS OF EXTENDED SCREENING PROGRAMS FOR SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE
Iris De kruif, Msc, University Medical Centre Utrecht, Utrecht, Netherlands and E. Buskens, University Medical Center Utrecht, Utrecht, Netherlands.
Purpose: Determine the balance between costs and effects of an elaborate vascular screening program and additional deployment of nurse practitioners to prevent cardiovascular events in high-risk people with symptomatic vascular disease. Methods: Using a decision model, care as usual (CAU) has been compared to a vascular screening program (VASPP) and to the vascular screening program with the deployment of nurse practitioners (VENUS) for people with symptomatic vascular disease at the age of 60. 10-Year risks of stroke, myocardial infarction and cardiovascular death have been estimated with the help of Framingham risk equations. Cost estimates were obtained from National cost-studies. The outcome-measure is life-years gained over a time-span of 20 years. Cost-effectiveness is expressed in terms of costs per life-year gained. Results: Patients who receive VASPP and additional consultation by a nurse practitioner have the highest remaining life-expectancy (18 years), followed by people who only received the vascular screening program (17.1 years) and people involved in CAU (17 years). Compared to CAU, the incremental costs per life year gained for VASPP amounted to € 243.952 per life-year gained and for VENUS € 5.377. Cost-effectiveness of VENUS compared to VASPP is € 1.437 per life-year gained. The cost-effectiveness of VENUS is mostly due to a lowered total cholesterol-level in combination with a raised HDL cholesterol-level among the VENUS-patients. Conclusion: Extended vascular screening cannot be considered cost-effective. The deployment of a nurse-practitioner on top of the screening programme, however, appears worthwhile and would yield life years. Compliance to medical treatment should be stressed by the nurse practitioner.