The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands

Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):371-6. doi: 10.1097/HJR.0b013e328329497a.


Background: A new Dutch guideline for cardiovascular disease management substantially extends the number of individuals for whom treatment with statins and/or antihypertensive agents is recommended. We estimated the cost-effectiveness of implementing the new guideline at the national level.

Methods: First, the number of currently untreated individuals who would become eligible for cholesterol-lowering or antihypertensive treatment under the new guideline was estimated using data from a recent population study. Cost-effectiveness of treating this group of patients was then assessed using a mathematical model.

Results: Implementing the guideline in the age category 30-69 years would lead to an additional 465,000 individuals requiring treatment. Over a period of 20 years, the cumulative incidence of acute myocardial infarction in the whole population would drop by 3.0%, that of stroke by 3.9%, and all-cause mortality would drop by 0.9%. The lifetime cost-effectiveness ratio was calculated to be 15,000 Euro per quality-adjusted life year gained. In the age categories 70-79 years and 80 years or above, an additional 600,000 and 450,000 persons, respectively, would need to be treated, resulting in corresponding reductions in cumulative incidences of 14 and 18% (acute myocardial infarction), 17 and 22% (stroke), and 1.2 and 0.6% (all-cause mortality) with cost-effectiveness ratios of 20,800 and 32,300 Euro, respectively, per quality-adjusted life year.

Conclusion: Complete implementation of the new guideline would lead to a considerable increase in the number of individuals requiring treatment. This would be cost-effective up to the age of 70 years.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / economics*
  • Antihypertensive Agents / therapeutic use
  • Cardiovascular Diseases / economics*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Drug Costs*
  • Female
  • Health Care Costs*
  • Health Services Accessibility / economics*
  • Health Services Research
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Middle Aged
  • Models, Economic
  • Myocardial Infarction / economics
  • Myocardial Infarction / prevention & control
  • Netherlands
  • Practice Guidelines as Topic
  • Primary Health Care / economics*
  • Quality-Adjusted Life Years
  • Risk Factors
  • Stroke / economics
  • Stroke / prevention & control
  • Treatment Outcome


  • Antihypertensive Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors