Identifying High-Value Care for Coronary Artery Disease in Australia

Synopsis

Why the research project is important

Coronary heart disease is still the leading cause of death in Australia. It is a chronic disease that often has negative effects on a person’s quality-of-life. It can also be costly to treat. There are three main treatment options, medical therapy, percutaneous coronary intervention and coronary artery bypass graft surgery, with different levels of invasiveness, risk and cost. Given the large numbers of people with coronary artery disease who require treatment, it is important to understand the cost-effectiveness of different treatment options.

Prior to this research, cost-effectiveness analyses in the Australian context had been undertaken comparing two treatments against each other, but not comparing all three together. In addition, many of these studies used clinical trial data, which is the gold standard for effectiveness evidence, but may not be the best evidence for real-world patient and practice. While it is a limitation of real-world, administrative data, that they lack detailed clinical information about individual patients, the strength for health services research lies in the fact the data show the trajectories of real patients outside the controlled environment of a trial.

What the research seeks to do

This project sought to evaluate the cost-effectiveness of all three treatments for stable coronary artery disease in Australia, using real-world linked data from private health insurance claims as well as cardiac registry data about quality-of-life outcomes and linked data about pharmaceutical prescriptions and Medicare service use.

What are the research outcomes / impact

The research found that optimal medical therapy was cost-effective compared to the more invasive and expensive options of percutaneous coronary intervention or coronary artery bypass graft surgery. Therefore, policies aimed at improving use of high-value care should focus on enabling access to optimal medical therapy and reserving more invasive treatments for those who fail to respond to medical therapy alone.

Outcomes

Critical review of previous cost-effectiveness studies

Analysis of pharmaceutical use for coronary artery disease

PhD thesis

As well as the completion of the PhD, this work resulted in a collaboration led by Prof Will Parsonage between researchers at Imperial College London, including lead ORBITA researcher Dr Rasha Al-Lamee, and AusHSI, to undertake a cost-effectiveness analysis using the trial data, culminating in our economic evaluation using ORBITA trial data.