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  • The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial

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Original article
Acute coronary syndromes
The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial
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  1. M Henriksson1,2,
  2. D M Epstein1,
  3. S J Palmer1,
  4. M J Sculpher1,
  5. T C Clayton3,
  6. S J Pocock3,
  7. R A Henderson4,
  8. M J Buxton5,
  9. K A A Fox6
  1. 1
    Centre for Health Economics, University of York, UK
  2. 2
    Center for Medical Technology Assessment, Linköping University, Sweden
  3. 3
    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
  4. 4
    Nottingham City Hospital NHS Trust, Nottingham UK
  5. 5
    Health Economics Research Group, Brunel University, Uxbridge, UK
  6. 6
    Centre for Cardiovascular Science, Department of Medical and Radiological Sciences, University of Edinburgh, UK
  1. Martin Henriksson, Center for Medical Technology Assessment, Linköping University, 581 83 Linköping, Sweden; martin.henriksson{at}ihs.liu.se

Abstract

Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.

Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.

Design: Decision-analytic model based on randomised clinical trial data.

Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.

Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients’ lifetimes within the decision-analytic model.

Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55 000, £22 000 and £12 000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20 000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.

Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.

https://doi.org/10.1136/hrt.2007.127340

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    Footnotes

    • ▸ Additional report is published online only at http://heart.bmj.com/content/vol94/issue6

    • Funding: RITA 3 was funded by a competitive grant from the British Heart Foundation, and the British Heart Foundation received a donation from Aventis Pharma. Additional governmental support (Culyer) was obtained to reimburse interventional centres for part of the costs of PCI procedures. The analysis and preparation of the manuscript were undertaken independently of the funding sources.

    • Competing interests: None.