Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease

Background We have shown that a case-based trainingprogramme for general practitioners, aimed to implement evidence-based care of patients at very high risk of coronary death, was associated with decreased mortality. In the present study we assessed long-term cost-effectiveness of this programme. Design Registry-based long-term cost-effectiveness analysis on a clinical trial. Methods Costs of the programme, health care, drugs and added years of life were included. Costs were adjusted to 2012 level and discounted by 3%. Life-years gained were estimated as the difference between the survival curves of the trial. The effectiveness measure, quality adjusted life-years (QALYs), was constructed by multiplying each life-year with a quality of life weight corresponding to the health status of that year. QALYs were also discounted by 3%. Incremental cost-effectiveness ratio (ICER) was estimated as the incremental cost per QALY gained. Results The number of undiscounted life-years gained was 365 days in the intervention group as compared to control (p=0.02). The number of discounted QALYs gained was 0.66. The net increase in total costs was estimated as 17,862 Euro when costs of added years of life were included and 4621 Euro exclusive of these costs. This implied an ICER of 27,063 Euro per gained QALY. This ICER is well below commonly used threshold values of the societal willingness to pay for a QALY. Conclusions The results show that a case-based training programme of general practitioners is a cost-effective way to save years of life in patients with very high risk of coronary death.