Andrew Boyden

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia

BACKGROUND The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model. METHODS A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented. RESULTS Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add

Current guidelines for the management of unstable angina: a new diagnostic and management paradigm.

115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the programs ICER is

Clinical effectiveness in everyday practice: improving outcomes for all patients through a national acute coronary syndrome data collaborative

8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to

Guidelines for the management of absolute cardiovascular disease risk

38 316 per DALY are observed in sensitivity analysis. CONCLUSIONS Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

Management of unstable angina: Guidelines 2000

The new guidelines reflect a worldwide change to more sensitive diagnostic strategies and more aggressive management of unstable angina. Stratification to high risk now includes those patients with only a minor degree of electrocardiographic ST depression (0.5 mm) or a significant elevation of cardiac troponin. High‐risk patients are recommended to be treated with intensive medical and invasive management. Intermediate‐risk patients may be best evaluated using an accelerated diagnostic strategy over an 8–12 h period before being reclassified as high or low risk. (Intern Med J 2001; 31: 104–111)

Acute coronary syndromes: consensus recommendations for translating knowledge into action

The management of acute coronary syndromes (ACS) has an extensive and impressive evidence‐base with which to guide clinical practice. Despite this, translation to the clinical environment has proved to be challenging and incomplete and can be attributed to patient, provider and system factors. Causes of suboptimal guideline adherence relate to diverse issues, including patient complexity, barriers in knowledge translation of guideline recommendations and a limited capacity within health services. Addressing these factors may enable more effective guideline implementation. In Australia, the infrastructure for clinical data management is fragmented, uncoordinated and often administratively driven, compromising access to important information, which might improve clinical effectiveness. An integrated approach is required to improve clinical effectiveness in ACS care in Australia. Greater access to information both to assist in clinical decision‐making and monitoring outcomes may help direct the focus towards understudied populations and improve performance and clinically relevant outcomes. A peer‐led initiative based on common datasets, providing rapid feedback, while developing and disseminating a ‘toolbox’ of proven and sustainable interventions, could improve clinical effectiveness in the Australian management of ACS and provides a rationale for a national ACS registry.