The economic evaluations of interventions for heart diseases

The primary aim of the thesis was to report new cost-effectiveness evidence in the clinical area of heart disease. Following a review of published empirical work, this was achieved by undertaking three new cost-effectiveness studies: one in nurse-led secondary prevention clinics for coronary heart disease in primary care, one on cardiac resynchronisation therapy with or without an implantable cardioverter defibrillator in chronic heart failure, and the final one on a new drug therapy, nebivolol, compared with standard treatment in elderly patients with heart failure. The second aim of the thesis concerned the application of modelling methodology, with the intent being the provision of general recommendations in using Markov modelling approaches in economic evaluation conducted in the heart disease area. The focus was on extrapolation of cost-effectiveness of an intervention beyond a trial both in terms of the time horizon of the analysis and in relation to the population involved. Fundamental issues in parametric distribution functions and Markov modelling approaches have been revisited, with detailed consideration of which parametric distribution functions should be employed when extrapolating beyond a trial and how they could be adopted into model-based analyses. The need for further methodology investigations in this area is discussed in conclusion