School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.
BMJ Open. 2023 Apr 25;13(4):e066106. doi: 10.1136/bmjopen-2022-066106.
We sought to establish the minimum level of clinical benefit attributable to the Victorian Cardiac Outcomes Registry (VCOR) for the registry to be cost-effective.
A modelled cost-effectiveness study of VCOR was conducted from the Australian healthcare system and societal perspectives.
Observed deaths and costs attributed to coronary heart disease (CHD) over a 5-year period (2014-2018) were compared with deaths and costs arising from a hypothetical situation which assumed that VCOR did not exist. Data from the Australian Bureau of Statistics and published sources were used to construct a decision analytic life table model to simulate the follow-up of Victorians aged ≥25 years for 5 years, or until death. The assumed contribution of VCOR to the proportional change in CHD mortality trend observed over the study period was varied to quantify the minimum level of clinical benefits required for the registry to be cost-effective. The marginal costs of VCOR operation and years of life saved (YoLS) were estimated.
The return on investment (ROI) ratio and the incremental cost-effectiveness ratio (ICER).
The minimum proportional change in CHD mortality attributed to VCOR required for the registry to be considered cost-effective was 0.125%. Assuming this clinical benefit, a net return of $A4.30 for every dollar invested in VCOR was estimated (ROI ratio over 5 years: 4.3 (95% CI 3.6 to 5.0)). The ICER estimated for VCOR was $A49 616 (95% CI $A42 228 to $A59 608) per YoLS. Sensitivity analyses found that the model was sensitive to the time horizon assumed and the extent of registry contribution to CHD mortality trends.
VCOR is likely cost-effective and represents a sound investment for the Victorian healthcare system. Our evaluation highlights the value of clinical quality registries in Australia.
我们旨在确定维多利亚心脏结局登记处（VCOR）达到最低临床获益水平，以使其具有成本效益。
从澳大利亚医疗保健系统和社会角度对 VCOR 进行了建模成本效益研究。
比较了 5 年期间（2014-2018 年）归因于冠心病（CHD）的观察死亡人数和成本，以及假设 VCOR 不存在的情况下出现的死亡人数和成本。使用澳大利亚统计局和已发表资料的数据构建决策分析生命表模型，以模拟年龄≥25 岁的维多利亚人 5 年的随访情况，或直至死亡。假设 VCOR 对研究期间观察到的 CHD 死亡率趋势的变化的贡献程度不同，以量化登记处具有成本效益所需的最低临床获益水平。估计了 VCOR 运营的边际成本和节省的生命年（YoLS）。
投资回报率（ROI）比率和增量成本效益比（ICER）。
为使登记处被认为具有成本效益，VCOR 归因于 CHD 死亡率的最小比例变化需达到 0.125%。假设这种临床获益，估计每投资 VCOR 1 美元，可获得 4.30 美元的净回报（5 年 ROI 比率：4.3（95%CI 3.6 至 5.0））。VCOR 的 ICER 估计值为每 YoLS 49616 澳元（95%CI 42228 至 59608 澳元）。敏感性分析发现，该模型对假设的时间范围和登记处对 CHD 死亡率趋势的贡献程度很敏感。
VCOR 可能具有成本效益，是维多利亚州医疗保健系统的一项合理投资。我们的评估突出了临床质量登记处在澳大利亚的价值。
