Challenges in Assessing the Cost-Effectiveness of cardiovascular disease technologies

Since healthcare expenditures are expected to rise in the future due to aging and the development of new medical technologies, it is necessary to spend the healthcare budget wisely. Cost-effectiveness analyses (CEA) can feed into making choices in allocating limited health care resources. Cardiovascular diseases (CVD) accounts for 9.2% of the total health care expenditure in the Netherlands. In this area many non-pharmaceutical technologies (e.g. stents, prostheses or diagnostic tests) are used to diagnose and treat patients with CVD. In the previous years, many new or improved non-pharmaceutical technologies came to the market and therefore it is important to estimate if these interventions are cost-effective compared to existing interventions. However, it is often challenging to accurately estimate the cost-effectiveness of these interventions due to a number of reasons. In this thesis, the aim was to assess the cost-effectiveness of various technologies in CVD and to identify and deal with challenges in the cost-effectiveness analysis methods. Several case studies were performed to identify the challenges and a review was performed to provide an overview of the challenges that arise in modelling the cost-effectiveness of cardiovascular interventions. The case studies focussed on the cost-effectiveness of diagnostic tests for primary and secondary prevention of CVD and coronary artery disease (CAD) and treatment strategies for CAD and aortic aneurysms. In addition, analyses of treatment variation and health related quality of life of patients diagnosed with CAD are performed