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Cost Effectiveness of a Clinical Decision Support System Based on the Recommendations of the European Society of Cardiology and Other Societies for the Management of Hypercholesterolemia

Report of a Cluster-Randomized Trial

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Introduction and objectives

To assess the cost effectiveness of a clinical decision support system (CDSS) based on the recommendations of the European Society of Cardiology and other societies for Hypercholesterolemia Management (ESCHM).

Study design and perspective

A cluster-randomized, unblinded, pragmatic trial was conducted. To assess the impact in effectiveness and costs of a CDSS implementing an adapted version of the ESCHM recommendations, a parallel comparison with a usual care group was carried out over 1 year. The recruitment period started in April 2000 and ended 1 year later. Effectiveness was defined as the achievement of the low-density lipoprotein-cholesterol (LDL-C) reduction goals in patients with initial cardiovascular risk (CVR) >20% over 10 years (the goals being LDL-C <115 mg/dL for patients with coronary heart disease [CHD], or LDL-C <130 mg/dL for patients without CHD), or keeping CVR <20% at study end in patients with initial CVR <20%. The costs of treatments, visits, and laboratory assessments were estimated from the social perspective (year of costing 2002).

Methods

The ESCHM guidelines adapted by a steering committee included therapeutic recommendations directed to achieve LDL-C objectives in a cost-effective manner. To promote healthy cardiovascular lifestyles, items such as table cloths and magnets for the refrigerator (with relevant promotional messages) were distributed to intervention practices. All study physicians recorded the patients’ data in a specific-purpose application installed on their computer. In the case of intervention physicians, the CDSS was installed as an additional module of this application and they were requested to use it but were otherwise free to adopt or ignore the recommendations. Adherence to the guideline was monitored by the CDSS. Patients with hypercholesterolemia were selected from 44 general practices in Spain, mainly in the Catalonia region.

Main outcome measures and results

2221 patients were included in the study (1161 in usual care group and 1060 in the intervention group). The intervention was shown to be as effective as usual care, both in an unadjusted analysis and after adjusting for absolute CVR and previous treatment with lipid-lowering drugs (LLDs) [odds ratio (OR) 1.02; 95% CI 0.58, 1.77]. The intervention had no impact on lipid profiles. Intervention patients were prescribed LLDs less frequently than usual care patients (OR = 0.37; 95% CI 0.26, 0.52; p = 0.0001), particularly when CVR was low. This induced important savings in treatments (p = 0.0001) and total costs (p = 0.001), which were estimated as 24.9% and 20.8%, respectively. The intervention increased the number of laboratory analyses. The recommendations issued by the CDSS were accepted in 71.3% of the visits.

Discussion and conclusions

The CDSS based on the recommendations of the ESCHM did not modify the effectiveness of usual care but induced considerable savings.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

Cardiocare Research Group: Via M, Alegre J, Muñoz M, Steiner E, Alvarado C (ABS Molí Nou, Sant Boi, Spain); Barceló C, Gens M, Bobé F, Ferrández MC, Palacios L (ABS Salou, Salou, Spain); Vilalta J, Basora T, Manrique E, Garola MD, Fernández M (ABS Riera Miró-Reus 4, Reus, Spain); Donado-Mazarrón A, Campaní M, Moltó E, Folch S, Isach A, Costa B (ABS Reus 2, Reus, Spain); Casadevall de la Herrán J, Inglés MR, Orús MA, Manero S, Rodríguez JM, Estrada P, Omonte J (ABS Casc Antic, Barcelona, Spain); Sorribes M, de León MR (EAP Riu Nord i Riu Sud — 4, Sta. Coloma de Gramanet, Spain); Montaña LM, Latre LM, Royo JM, García M, Segarra M, Buera E, Aviñó T, Valen E (CAP Flix, Flix, Spain); Sancho A, Muñoz D, Morató T (ABS-1 Centre Can Mariné, Sta. Coloma de Gramanet, Spain); Marín J, Llobet P, Andreu M, Euba R, Iglesias PF (ABS Montroig del Camp, Montroig del Camp, Spain); Benet JM, Caballero JC (CAP Roquetes. ABS Garraf Rural, Roquetes de Mar, Spain); Palacio F, Dolz F, Boj J, Descàrrega R (CAP St Jordi — Reus III, Reus, Spain); Alvarez M, Pérez S (ABS La Llagosta, La Llagosta, Spain); Martos J, Calvera R, Antoja P, Canals J, Vila C (ABS Martorelles, Martorelles, Spain); Araque J, Benaiges D, Dobon A, Fuster J, Martínez MP, Moreno R, Perolada JF, Pintado JE, Tiñena F (ABS Móra La Nova, Móra la Nova, Spain); Aguilar LC, Maseda S, Ribera M (ABS Parets, Parets, Spain); Puig J (ABS Sabadell 7, Sabadell, Spain); González M, Roselló MD (EAP Raval Nord-ABS Dr. Sayé, Barcelona, Spain); Forn MC, Jiménez JR, Loscos J, Venarell MJ (ABS Agramunt, Agramunt, Spain); Moya A, Herranz M, Gálvez E, Batlle PJS, Salido A, Martínez I (ABS Castellar, Castellar del Vallés, Spain); García C (ABS Les Borges del Camp, Borges del Camp, Spain); Cabré JJ, García JM, Fugola JL, Martín F, Montañés MD, Sánchez-Oro MI (ABS Reus — 1, Reus, Spain); Cabré R, Casal R, MJ de Andrés, Gastón E, Hernández JM, Rodríguez R, Subirats R, Valldosera C (ABS Falset, Falset, Spain); Carmona M (CAP Sant Llorenç de Savall, Sant Llorenç de Savall, Spain); Guzmán MC (ABS La Salut, Badalona, Spain), Bertral C (ABS Anoia Rural-Igualada, Igualada, Spain); Viñas L, Pons J (ABS Tortosa Oest, Tortosa, Spain); Pujol R, Torras A, Cartero JM, Remón JL (ABS Tremp, Tremp, Spain); Olasolo S (ABS Castelldefels, Castelldefels, Spain); Simonet P, Villafáfila R, Bravo JL, García MC, Bentué C, Verduras MC (ABS Viladecans 2, Viladecans, Spain); Armengol F, Mateu RM, Ibars J, Teixido F, Adnan-Mahmud T (ABS Almenar-Alfarràs, Almenar-Alfarràs, Spain); García MG, Roig I (ABS Manresa 4-CAP Sagrada Familia, Manresa, Spain); Zambudio J, Espinós MC, Riera C, Vilarrubia M, Cantero X, Celles P (ABS Igualada urbà, Igualada, Spain); Masqué, Caballol, Rubio, Ramón (ABS Amposta, Amposta, Spain), García G, Clúa J, Dalmau MR (ABS Tortosa Est- El Temple, Tortosa, Spain); Garde A, Brossa A, Tobías J, Soler M, Vivancos R (ABS Manresa-CAP Plça Catalunya, Manresa, Spain); Pagès A, Hernández S, MD Gil (CAP Jaume I, Tarragona, Spain); Morales JA (ABS Borges Blanques, Borges Blanques, Spain); Martorell J, Granell J, Vera G, Camacho JM, Bobadilla ML, Camps I (ABS Cervera, Cervera, Spain); Comino J (ABS Terra Alta, Gandesa, Spain), Comino L (ABS Alt Camp Est, Nulles, Spain), Rosado A (CS San Andrés II, Villaverde Alto, Spain), Apecechea K, Martín A (EAP Linneo, Madrid, Spain), Castellanos FJ, González J (CS Potes-San Andrés I; Villaverde Alto, Spain); Segura R, MC Álvarez (CS Embajadores, Madrid, Spain).

Study supported by the Department of Outcomes Research & Disease Management, Novartis Farmacéutica SA, Spain.

The authors thank Silvia Muñío, Juan Bigorra from Novartis Farmacéutica SA, Spain, and the Agencia de Evaluación de Tecnologías Sanitarias for helpful discussions during the study design; Clara Pujol and Bonaventura Bolívar from the Fundación Gol I Gurina for their support to the study; and Gemma Gambús (Novartis Farmacéutica SA, Spain) and Jesús González (Agencia de Evaluación de Tecnologías Sanitarias) for the review of the final manuscript. We also thank Novartis Farmacéutica SA, Spain, for the funding of the study.

Albert Cobos and Salvador Bergoñón were employed by RDES, SL, the contract research organization that conducted this study. Christina Espinosa and Eva Torremadé were employed by Novartis Farmacéutica SA, Spain. All remaining co-authors were contracted as consultants.

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Authors and Affiliations

  1. RDES, SL, Barcelona, Spain

    Albert Cobos MD, PhD, MSc (Technical Director of RDES, SL, and part-time lecturer of Biostatistics) & Salvador Bergoñón

  2. ABS Sant Josep, L’Hospitalet de Llobregat, Barcelona, Spain

    Jordi Vilaseca

  3. CAP Dr Martí i Julia, Cornelia, Spain

    César Asenjo

  4. Departament of Medicine, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain

    Juan Pedro-Botet

  5. Servei Català de la Salut, Barcelona, Spain

    Emilia Sánchez

  6. ABS Camps Blancs, Barcelona, Spain

    Alicia Val

  7. Department of Outcomes Research & Disease Management, Novartis Farmacéutica SA, Barcelona, Spain

    Eva Torremadé & Cristina Espinosa

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  1. Albert Cobos MD, PhD, MSc
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  2. Jordi Vilaseca
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  3. César Asenjo
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  4. Juan Pedro-Botet
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  5. Emilia Sánchez
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  6. Alicia Val
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  7. Eva Torremadé
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  8. Cristina Espinosa
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  9. Salvador Bergoñón
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Corresponding author

Correspondence to Albert Cobos MD, PhD, MSc.

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Cobos, A., Vilaseca, J., Asenjo, C. et al. Cost Effectiveness of a Clinical Decision Support System Based on the Recommendations of the European Society of Cardiology and Other Societies for the Management of Hypercholesterolemia. Dis-Manage-Health-Outcomes 13, 421–432 (2005). https://doi.org/10.2165/00115677-200513060-00007

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