Author + information
- Sandra Mileva,b,
- Marissa Bliedena,b,
- Hyosung Junga,b,
- Meredith Hooga,b,
- Yi Qiana,b,
- Christine Edwardsa,b,
- Guillermo Villaa,b,
- Lucie Kutikovaa,b,
- Alexandra Warda,b and
- Anne Beaubruna,b
Background: Health technology assessment (HTA) bodies consider cost-effectiveness in their value assessment frameworks and use cardiovascular disease (CV) risk equations to predict individual patient or population risk. The aim of this study was to a) identify CV risk equations that are most commonly used in health economic evaluations for primary and secondary prevention submitted to HTA bodies and b) assess their alignment with the clinical guidelines (CG) recommendations.
Methods: A search of HTA body websites and CG databases in the past 10 years was conducted for Australia, Canada, Europe, and US. Articles referring to CV risk equations in primary and secondary prevention settings were identified and relevant commentary documented. Any relevant publications referenced by these articles were further considered for review.
Results: The searches identified 17 primary and 11 secondary prevention equations, with more risk equations referred to in CG (22) than in HTA reports (6). Framingham, ASSIGN, and QRISK2 were the preferred equations in primary prevention settings cited by HTA agencies in Australia, Scotland, and England respectively, while SCORE was preferred for Norway and Sweden HTA groups. The CG recommendations for these countries align with the HTA recommendations, although additional equations in CG have been referred as available options. US CG recommended Pooled Cohort, Framingham (2008), and Reynolds risk equations, in addition to listing more options. HTA bodies identified various reasons for inappropriate use of risk equations to inform reimbursement decision-making in the population of interest, including risk over- and under-estimation, outdated evidence and absence of relevant predictors. Only US CG identified risk equations for secondary prevention, except REACH generating negative comments in the Swedish and no comments in the Scottish HTA.
Conclusions: Although large numbers of risk equations are available, there is less variation in their use for economic evaluation by HTAs than in CGs. While the aims for assessing CV risk may be different, the critiques by HTAs around the world may be valuable for consideration of appropriate risk equation in value-driven frameworks.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-070
- 2017 American College of Cardiology Foundation