[Economic evaluation of different treatment strategies in patients with stable angina pectoris or asymptomatic myocardial ischemia on basis of results from the Asymptomatic-Cardiac-Ischemia Pilot study (ACIP)].
BACKGROUND
In patients with stable angina pectoris or silent myocardial ischemia, who had signs of ischemia in ECG during exercise, the Asymptomatic Cardiac Ischemia Pilot (ACIP) study compared 2 types of medication strategies (ischemia-guided and angina-guided) and a strategy of primary revascularization by PTCA or CABG. ACIP substantiated, after 2 years of observation, a clear advantage of the revascularization strategy compared to both drug strategies in terms of clinical effectiveness. This advantage is even more distinct in patients with very severe angiographic results.


METHODS
This is a retrospective, incremental cost-effectiveness analysis from the perspective of the German third party payer (statutory sick funds) on the basis of the ACIP study.


RESULTS
The direct costs of the revascularization strategy after 2 years are about 2 to 3 times higher than those of the drug therapies. The incremental cost-effectiveness of the ischemia-guided strategy versus an angina-guided strategy is DM 2,600 per life-year saved. Furthermore, the cost-effectiveness of a revascularization strategy versus an angina guided therapy is DM 15,100 per life-year saved.


CONCLUSIONS
A primary revascularization strategy is cost-effective in patients with stable coronary artery disease with proven myocardial ischemia and positive angiographic signs.
Szucs
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TD
Abteilung Medizinische Okonomie, Universitätsspital, Zürich, Schweiz. thomas.szucs@vdi.usz.ch
Schwenkglenks
M
M
Rutishauser
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W
D000368:Aged; D000787:Angina Pectoris / Q000191:economics / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000191:economics; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000191:economics / Q000628:therapy; D009204:Myocardial Revascularization / Q000191:economics*; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016037:Single-Blind Method; D016019:Survival Analysis
D002317:Cardiovascular Agents