Economic implications of cardiovascular disease management programs: moving beyond one-off experiments

Abstract

Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost–effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost–effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost–effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

Keywords:

• cardiovascular disease
• cost–effectiveness
• disease management
• economic evaluation
• heart failure

Financial & competing interests disclosure

This work was supported by a National Health and Medical Research Council of Australia program grant (grant 519823). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Despite the expectation that cardiovascular disease management programs may reduce costs while improving health outcomes, the results of cost–effectiveness analyses remain equivocal.

• Substantial variation in intervention content, methodology and reporting practice has hindered comparability across studies and replication of findings, limiting the ability to infer what type of intervention works for which patient population.

• Practical tools exist to increase awareness of the key dimensions to be addressed, increase comparability across studies, or at least allow the replication of the intervention conducted in a single trial.