In the Journals

Financial incentives aid in LDL control in high CVD risk

A cost-effective intervention to control LDL in patients at high risk for CVD may be financial incentives for both patients and their physicians, according to a study published in JAMA Network Open.

“Financial incentive interventions are only effective sometimes,” Ankur Pandya, PhD, assistant professor of health decision science in the department of health policy and management at Harvard T.H. Chan School of Public Health, said in a press release. “When these programs show health benefits, the next question should be whether the health gains are worth the added costs, which is what we modeled in this study.”

Model vs. population

Researchers analyzed data from the CVD PREDICT model (n = 1 million; mean age, 62 years; 31% women) and an observed trial population (n = 1,503; mean age, 62 years; 43% women) from April 15, 2016, to March 29, 2018. The CVD PREDICT model featured three disease states: disease-free; stroke; and CHD, which was divided into angina, MI and cardiac arrest.

Five possible strategies were simulated in each patient: usual care such as a virtual control group; trial control group using electronic pill bottles and increased monitoring; physician incentives; patient incentives; and shared incentives for both patients and physicians. LDL level reductions were translated into CV risk reduction for each incentive strategy.

Quality-adjusted life-years were used to quantify health effects for each strategy. The health care payer perspective was considered for health care costs.

The mean LDL in the model population was 153.9 mg/dL vs. 160.6 mg/dL for the observed trial population, the researchers wrote.

According to base-case assumptions, which included a 10-year waning period for LDL reductions, the usual-care strategy was dominated by the other strategies regarding higher costs and lower QALYs.

The shared-incentives strategy performed better compared with patient- or physician-only incentives. The incremental cost-effectiveness ratio for shared-incentive strategies was $60,000 per QALY vs. the trial control strategy.

Lasting LDL reductions

For scenarios in which LDL reductions lasted at least 7 years with linear waning, the incremental cost-effectiveness ratio for the shared-incentives strategy was less than $100,000 per QALY, according to the data. The ratio was less than $150,000 per QALY for LDL reductions that lasted at least 5 years with linear waning.

At 11 years, the incremental cost-effectiveness ratio for the shared-incentives strategy exceeded $100,000 per QALY. It exceeded $150,000 per QALY at 8 years, the researchers reported.

When cost-effectiveness thresholds of $100,000 to $150,000 per QALY was used, the shared-incentives intervention was cost-effective in 69% to 77% of iterations.

“Given both the promise of the intervention and the importance of duration of LDL-C level reductions on our model-based results, we believe a large-scale demonstration for the shared-incentives strategy with at least 5 years of follow-up is warranted by the Centers for Medicare & Medicaid Services or private health care payers to test this strategy in a real-world setting,” Pandya and colleagues wrote. – by Darlene Dobkowski

Disclosures: Pandya reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

A cost-effective intervention to control LDL in patients at high risk for CVD may be financial incentives for both patients and their physicians, according to a study published in JAMA Network Open.

“Financial incentive interventions are only effective sometimes,” Ankur Pandya, PhD, assistant professor of health decision science in the department of health policy and management at Harvard T.H. Chan School of Public Health, said in a press release. “When these programs show health benefits, the next question should be whether the health gains are worth the added costs, which is what we modeled in this study.”

Model vs. population

Researchers analyzed data from the CVD PREDICT model (n = 1 million; mean age, 62 years; 31% women) and an observed trial population (n = 1,503; mean age, 62 years; 43% women) from April 15, 2016, to March 29, 2018. The CVD PREDICT model featured three disease states: disease-free; stroke; and CHD, which was divided into angina, MI and cardiac arrest.

Five possible strategies were simulated in each patient: usual care such as a virtual control group; trial control group using electronic pill bottles and increased monitoring; physician incentives; patient incentives; and shared incentives for both patients and physicians. LDL level reductions were translated into CV risk reduction for each incentive strategy.

Quality-adjusted life-years were used to quantify health effects for each strategy. The health care payer perspective was considered for health care costs.

The mean LDL in the model population was 153.9 mg/dL vs. 160.6 mg/dL for the observed trial population, the researchers wrote.

According to base-case assumptions, which included a 10-year waning period for LDL reductions, the usual-care strategy was dominated by the other strategies regarding higher costs and lower QALYs.

The shared-incentives strategy performed better compared with patient- or physician-only incentives. The incremental cost-effectiveness ratio for shared-incentive strategies was $60,000 per QALY vs. the trial control strategy.

Lasting LDL reductions

For scenarios in which LDL reductions lasted at least 7 years with linear waning, the incremental cost-effectiveness ratio for the shared-incentives strategy was less than $100,000 per QALY, according to the data. The ratio was less than $150,000 per QALY for LDL reductions that lasted at least 5 years with linear waning.

At 11 years, the incremental cost-effectiveness ratio for the shared-incentives strategy exceeded $100,000 per QALY. It exceeded $150,000 per QALY at 8 years, the researchers reported.

When cost-effectiveness thresholds of $100,000 to $150,000 per QALY was used, the shared-incentives intervention was cost-effective in 69% to 77% of iterations.

“Given both the promise of the intervention and the importance of duration of LDL-C level reductions on our model-based results, we believe a large-scale demonstration for the shared-incentives strategy with at least 5 years of follow-up is warranted by the Centers for Medicare & Medicaid Services or private health care payers to test this strategy in a real-world setting,” Pandya and colleagues wrote. – by Darlene Dobkowski

Disclosures: Pandya reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.