Estimating the cost-effectiveness and return on investment of the Victorian Cardiac Outcomes Registry in Australia: a minimum threshold analysis.

We sought to establish the minimum level of clinical benefit attributable to the Victorian Cardiac Outcomes Registry (VCOR) for the registry to be cost-effective. A modelled cost-effectiveness study of VCOR was conducted from the Australian healthcare system and societal perspectives. Observed deaths and costs attributed to coronary heart disease (CHD) over a 5-year period (2014-2018) were compared with deaths and costs arising from a hypothetical situation which assumed that VCOR did not exist. Data from the Australian Bureau of Statistics and published sources were used to construct a decision analytic life table model to simulate the follow-up of Victorians aged ≥25 years for 5 years, or until death. The assumed contribution of VCOR to the proportional change in CHD mortality trend observed over the study period was varied to quantify the minimum level of clinical benefits required for the registry to be cost-effective. The marginal costs of VCOR operation and years of life saved (YoLS) were estimated. The return on investment (ROI) ratio and the incremental cost-effectiveness ratio (ICER). The minimum proportional change in CHD mortality attributed to VCOR required for the registry to be considered cost-effective was 0.125%. Assuming this clinical benefit, a net return of $A4.30 for every dollar invested in VCOR was estimated (ROI ratio over 5 years: 4.3 (95% CI 3.6 to 5.0)). The ICER estimated for VCOR was $A49 616 (95% CI $A42 228 to $A59 608) per YoLS. Sensitivity analyses found that the model was sensitive to the time horizon assumed and the extent of registry contribution to CHD mortality trends. VCOR is likely cost-effective and represents a sound investment for the Victorian healthcare system. Our evaluation highlights the value of clinical quality registries in Australia.

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Competing interests: PL is supported by an Australian Government Research Training Program (RTP) scholarship. EZ has received grants from Amgen, AstraZeneca, Pfizer, Shire and Zoll Medical, outside the submitted work. DL has received honoraria or study grants from AbbVie, Amgen, Astellas, AstraZeneca, Bohringer Ingelheim, Bristol Myers Squibb, Novartis, Pfizer, Sanofi, Shire and Zoll Medical, outside the submitted work. DS is supported by the National Heart Foundation Fellowship and Viertel Foundation Award. CMR is supported by a National Health and Medical Research Council Principal Research Fellowship (GNT1136372). All other authors have no conflicts of interest to disclose.