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Using electronic health records to predict costs and outcomes in stable coronary artery disease
  1. Miqdad Asaria1,
  2. Simon Walker1,
  3. Stephen Palmer1,
  4. Chris P Gale2,
  5. Anoop D Shah3,
  6. Keith R Abrams4,
  7. Michael Crowther4,
  8. Andrea Manca1,
  9. Adam Timmis5,
  10. Harry Hemingway3,
  11. Mark Sculpher1
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  3. 3Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College, London, UK
  4. 4Department of Health Sciences, University of Leicester, Leicester, UK
  5. 5NIHR Biomedical Research Unit, Barts and the London NHS Trust, London, UK
  1. Correspondence to Miqdad Asaria, Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK; miqdad.asaria{at}york.ac.uk

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.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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