Study on conflict between capacity to pay and need for health care

Cardiovascular disease (CVD) in all its forms is the biggest cause of death across Europe. Although there is little doubt that better focus on prevention can lessen its impact, we are left with a series of fundamental questions….to what extent can the impact be reduced, and at what cost? And are the health benefits of prevention worth the investment? The EUROASPIRE III health economics study aims to find out.

In Europe, more than four million deaths are directly caused by CVD each year. Not only is it the main cause of death, treatment of CVD also consumes a significant proportion of national health care budgets. Consequently, it imposes a huge burden on both the patients affected and the wider society that foots the bill. Yet through improved control of risk factors, as described in clinical practice guidelines issued by the Joint European Societies, cardiovascular prevention can reduce the impact of CVD. Lowering the risk can be achieved by modifying lifestyle (for instance by undertaking more physical activity or by stopping smoking), as well as through the use of statins, antiplatelet therapies, antithrombotic strategies, ACE inhibitors and β-blockers.

Research lead, Professor Lieven Annemans of Ghent University, recognises the growing conflict between what societies are able to pay for health care and the population's need for that health care. He says, "Societies can no longer afford to pay for major investments in health that deliver only minor benefits. We need to think in terms of health economics, and find the best way to spend the monies available in order to produce as much 'health' as possible. Healthcare needs to be seen almost as a productive sector, where the aim is to ensure that people live longer and more healthily."

In this scenario, priority would be given to those interventions that result in the greatest amount of health for the money that is invested - in simple terms, interventions that are the most cost-effective or can prove their value. In Europe, this concept of cost-effectiveness is gaining more and more appeal, and it has an increasing influence upon the pricing and reimbursing of technologies, drugs and interventions.

To evaluate health economics, the net costs of investments are compared with the current alternatives, and the ratio between net costs and net health benefits is then assessed. Many countries have developed guidelines to assist researchers in conducting health economic evaluations, but not all countries handle the assessment of technologies, drugs and interventions in the same way. In some, health economic evaluations are mandatory, while in others, they are merely recommended. And some countries do not regard them as important at all. Healthcare decision makers, however, consider them very useful.

Seven European countries (Belgium, Bulgaria, Finland, France, Italy, Poland and U.K.) are participating in the EUROASPIRE III health economics study. Professor Annemans says, "Through this study, our aim is to assess the cost-effectiveness of prevention in patients with and without established CVD, by following the Joint European Societies' guidelines. It will tackle both primary and secondary prevention of cardiovascular disease in two separate analyses. The study will also help to identify the drivers of the relationship between the costs and effects of prevention, and will also model the health and economic outcomes of prevention compared with the current situation."

Source : Ghent University