Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia
Derek P. Chew A E , Robert Carter B , Bree Rankin C , Andrew Boyden D and Helen Egan DA Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, SA 5042, Australia.
B Deakin University, Burwood Campus, Burwood, VIC 3125, Australia.
C Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Carlton, VIC 3053, Australia.
D Heart Foundation Australia, Deakin, ACT 2600, Australia.
E Corresponding author. Email: derek.chew@flinders.edu.au
Australian Health Review 34(2) 162-169 https://doi.org/10.1071/AH09742
Submitted: 2 February 2009 Accepted: 3 July 2009 Published: 25 May 2010
Abstract
Background. The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model.
Methods. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented.
Results. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program’s ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis.
Conclusions. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.
What is known about this topic? Chronic disease management programs are known to provide gains with respect to reductions in death and disability among patients with coronary heart disease. The cost effectiveness of such programs in the Australian context is not known.
What does this paper add? This paper suggests that implementing a coronary heart disease program in Australia is highly cost-effective across a broad range of assumptions of uptake and effectiveness.
What are the implications for practitioners? These data provide the economic rationale for the implementation of a chronic disease management program with a disease registry and regular review in Australia.
Additional keywords: coronary heart disease management programs, coronary heart disease prevention.
Acknowledgements
This work was overseen by the National Heart Foundation of Australia CHD-GP Working Group. Members of the Working Group are as follows: Andrew Boyden (National Heart Foundation of Australia); Robert Carter (University of Melbourne); Derek Chew (Flinders University); Andrew Dalton (University of Melbourne, Adhealth); Helen Egan (National Heart Foundation of Australia); Lisa Gold (La Trobe University); Nancy Huang (National Heart Foundation of Australia); Jeanie McKenzie (National Heart Foundation of Australia); Bree Rankin (University of Melbourne); Anthony Scott (University of Melbourne); and Shiong Tan (General Practice and WA Health). We also acknowledge Peter Sexton and Eleanor Clune who reviewed and provided comments on this paper.
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