Authors: Peter Lee1,2, Angela L Brennan1, Dion Stub1,3, Diem T Dinh1, Jeffrey Lefkovits1,4, Christopher M Reid1,5, Ella Zomer1, Danny Liew1,6

Affiliations:

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

2School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia

3Cardiology Department, Alfred Hospital, Melbourne, Victoria, Australia

4Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia

5Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia

6Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia

Summary:

Coronary heart disease (CHD) is a significant health issue in Australia, with a prevalence of 3% in adults, causing 10% of deaths. Standard procedures to manage CHD and blockages to the heart's blood supply include a percutaneous coronary intervention (PCI), whereby a small inflatable balloon unblocks the artery. The economic burden is substantial, particularly from percutaneous coronary intervention (PCI). In 2018-2019, CHD accounted for $2.35 billion in health expenditure. Clinical Quality Registries (CQRs), such as the Victorian Cardiac Outcomes Registry (VCOR), aim to improve healthcare by collecting data on patient outcomes. VCOR’s impact on patient outcomes, cost efficiency, and guideline adherence is under investigation. Previous studies suggest that CQRs contribute to improved outcomes, but assessing their specific impact remains challenging. As such, the researchers focused on determining the minimum contribution needed for VCOR to be considered cost-effective and beneficial for the healthcare system.

The study utilised life table modelling and decision analysis to assess the clinical and cost impacts of the VCOR compared to a hypothetical scenario without VCOR. The model focused on the population aged ≥ 25 years in Victoria from 2014 to 2018, with a separate dataset from VCOR providing information on trends in clinical practice across Victorian hospitals. The effectiveness of VCOR was evaluated by varying its contribution to the reduction in CHD mortality over time-based on changes in clinical management, which may be attributed to registry operation. These included differences in the uptake of percutaneous coronary intervention (PCI) accessed via the arm and timely treatment. Over four years (2014-2017), there was an annual decline (≥ 26%) in the use of PCI accessed via the leg, while the likelihood of timely treatment for patients with severe heart attacks increased annually by at least 15%.

In the primary economic analysis, variations in the assumed contribution of the Victorian Cardiac Outcomes Registry (VCOR) were explored, revealing that a minimum proportional reduction of 0.125% in coronary heart disease (CHD) mortality was necessary for VCOR to be cost-effective. Assuming this, VCOR contributed to preventing 23 CHD-related deaths, saving 53 years of life, and avoiding $120,783 in costs. However, there was a higher incidence of non-CHD mortality in the VCOR cohort, resulting in an additional cost of $14,941. The VCOR cost was $ 2.7 million, with a net expenditure of $2,621,728 (discounted) from the healthcare system perspective. The Incremental Cost-Effectiveness Ratio (ICER) associated with VCOR was $49,616 per Year of Life Saved (YoLS). From a societal perspective, VCOR generated savings of $11,638,633, yielding a Return on Investment (ROI) ratio of 4.3 (95% CI: 3.6 – 5); a return of $4.30 was estimated for every $1 invested in VCOR.

In Australia, various cardiac clinical quality registries (CQRs) operate in different settings, underscoring the importance of these registries in improving patient outcomes. Overall, this study highlights the significance of cardiac CQRs in health systems benchmarking and feedback and the potential value of registries. Further, refining the benchmarking of key clinical performance indicators can offset the costs of registry set-up and maintenance. This information helps facilitate the design of CQRs by health policymakers and decision-makers in Australia.

Source: Photo by Robina Weermeijer on Unsplash