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 forthe 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.
Improved medical therapies and an increased use of coronary revascularisation have been associated with a decline in the acute mortality associated with acute coronary syndromes. However, the burden of chronic coronary heart disease (CHD) and other forms of cardiovascular disease remains high, with CHD and stroke as the two leading single causes of death in Australia.
Clinical research is rich in evidence documenting the robust benefits of lifestyle and phannacologic interventions for people with CHD.2"" However, both international and local studies demonstrate that the application of these therapies is incomplete, and persistence of therapy is suboptimal.6'7 Therefore, a key strategic approach to improve the health and wellbeing of Australians living with CHD is to target the evidence-management gap by providing national supports and incentives to optimise the delivery of proven therapies and the achievement of treatment goals among these complex patients. Such an approach may be of particular benefit to populations which carry a greater CHD burden; specifically Aboriginal and Torres Strait Islander populations (who in 2000-02 died from CHD at 2.6 times the rate of other Australians8) and rural and regional populations, where rates of death from cardiovascular disease appear to be higher than in urban areas, and access to specialised medical services is more difficult.
This type of initiative has been successfully implemented in diabetes, asthma and mental health management, immunisation and cervical cancer screening. To date, there has been no equivalent level of recognition for CHD care that is accessible to all general practices, although the Australian Primary Care Collaboratives is a positive initiative that has enhanced CHD care in several participating practices (see http;//www. …