Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness (PRIMROSE)

ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.SettingPrimary care setting in the UK. The analysis was from the National Hea...

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Published inBMJ open Vol. 7; no. 9; p. e018181
Main Authors Zomer, Ella, Osborn, David, Nazareth, Irwin, Blackburn, Ruth, Burton, Alexandra, Hardoon, Sarah, Holt, Richard Ian Gregory, King, Michael, Marston, Louise, Morris, Stephen, Omar, Rumana, Petersen, Irene, Walters, Kate, Hunter, Rachael Maree
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.09.2017
BMJ Publishing Group
Subjects
Adult
Aged
Algorithms
Bipolar disorder
Body Mass Index
Cardiovascular disease
Cardiovascular Diseases - economics
Cardiovascular Diseases - mortality
Cost-Benefit Analysis
Databases, Factual
Female
Health Economics
Health risk assessment
Humans
Male
Mental disorders
Mental Disorders - complications
Mental health
Middle Aged
Models, Economic
Primary Health Care
Psychotropic drugs
Quality-Adjusted Life Years
Risk Assessment
Risk Factors
Sampling Studies
State Medicine - economics
United Kingdom - epidemiology
United Kingdom > UK
mental health
coronary heart disease
health economics
Online AccessGet full text
ISSN2044-6055
2044-6055
DOI10.1136/bmjopen-2017-018181

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Abstract ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.SettingPrimary care setting in the UK. The analysis was from the National Health Service perspective.Participants1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years and without existing CVD, populated the model.InterventionsFour cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (> 10%) were assumed to be prescribed statin therapy while others received usual care.Primary and secondary outcome measuresQuality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.ResultsThe SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
AbstractList To determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI. Primary care setting in the UK. The analysis was from the National Health Service perspective. 1000 individuals with SMI from The Health Improvement Network Database, aged 30-74 years and without existing CVD, populated the model. Four cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk ( 10%) were assumed to be prescribed statin therapy while others received usual care. Quality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates. The SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000). The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.SettingPrimary care setting in the UK. The analysis was from the National Health Service perspective.Participants1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years and without existing CVD, populated the model.InterventionsFour cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (>10%) were assumed to be prescribed statin therapy while others received usual care.Primary and secondary outcome measuresQuality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.ResultsThe SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
To determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.OBJECTIVESTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.Primary care setting in the UK. The analysis was from the National Health Service perspective.SETTINGPrimary care setting in the UK. The analysis was from the National Health Service perspective.1000 individuals with SMI from The Health Improvement Network Database, aged 30-74 years and without existing CVD, populated the model.PARTICIPANTS1000 individuals with SMI from The Health Improvement Network Database, aged 30-74 years and without existing CVD, populated the model.Four cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (> 10%) were assumed to be prescribed statin therapy while others received usual care.INTERVENTIONSFour cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (> 10%) were assumed to be prescribed statin therapy while others received usual care.Quality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.PRIMARY AND SECONDARY OUTCOME MEASURESQuality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.The SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).RESULTSThe SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.CONCLUSIONSThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
Author Omar, Rumana
Osborn, David
Nazareth, Irwin
Walters, Kate
Morris, Stephen
Petersen, Irene
Zomer, Ella
Burton, Alexandra
Blackburn, Ruth
Hunter, Rachael Maree
King, Michael
Marston, Louise
Hardoon, Sarah
Holt, Richard Ian Gregory
AuthorAffiliation 6 Department of Applied Health Research, Faculty of Population Health Sciences , University College London , London , UK
7 Department of Statistical Science, Faculty of Mathematical and Physical Sciences , University College London , London , UK
1 Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Australia
2 Department of Primary Care and Population Health, Faculty of Population Health Sciences , University College London , London , UK
3 Division of Psychiatry, Faculty of Brain Sciences , University College London , London , UK
5 Human Development and Health Academic Unit, Faculty of Medicine , University of Southampton , Southampton , UK
4 Camden and Islington National Health Service Foundation Trust , London , UK
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Keywords mental health
coronary heart disease
health economics
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Publisher BMJ Publishing Group LTD
BMJ Publishing Group
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SSID ssj0000459552
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Snippet ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for...
To determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary...
SourceID unpaywall
pubmedcentral
proquest
pubmed
crossref
bmj
SourceType Open Access Repository
Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage e018181
SubjectTerms Adult
Aged
Algorithms
Bipolar disorder
Body Mass Index
Cardiovascular disease
Cardiovascular Diseases - economics
Cardiovascular Diseases - mortality
Cost-Benefit Analysis
Databases, Factual
Female
Health Economics
Health risk assessment
Humans
Male
Mental disorders
Mental Disorders - complications
Mental health
Middle Aged
Models, Economic
Primary Health Care
Psychotropic drugs
Quality-Adjusted Life Years
Risk Assessment
Risk Factors
Sampling Studies
State Medicine - economics
United Kingdom - epidemiology
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Title Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness (PRIMROSE)
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