Coronary angioplasty versus medical therapy for angina. Health service costs based on the second Randomized Intervention Treatment of Angina (RITA-2) trial.
OBJECTIVE
The second Randomized Intervention Treatment of Angina (RITA-2) trial compares an initial strategy of PTCA with continued medical management in patients with arteriographically proven coronary artery disease. This paper employs resource use data collected in the trial to compare the health service costs of the two strategies over 3 years follow-up.


RESULTS
1018 patients were randomized, 504 to PTCA and 514 to continued medical management. Health service resource use data were collected prospectively on all patients. Hospital unit costs were estimated in collaboration with five U.K. centres. PTCA patients underwent more subsequent coronary arteriograms, but subsequent (non-randomized) PTCAs were more common in patients randomized to medical management (118 procedures in 102 patients) compared to those randomized to PTCA (73 procedures in 62 patients). The likelihood of undergoing CABG was similar in the two groups. The use of antianginal medications was higher in patients randomized to an initial strategy of medical management. There was an overall mean additional cost per patient over 3 years in patients randomized to PTCA of pound 2685 (95% CI pound 2074- pound 3322).


CONCLUSIONS
In RITA-2, the cost of an initial strategy of PTCA exceeded the cost of an initial strategy of medical management by 74% over 3 years.
Sculpher
M
M
Centre for Health Economics, University of York, York, UK.
Smith
D
D
Clayton
T
T
Henderson
R
R
Buxton
M
M
Pocock
S
S
Chamberlain
D
D
D000787:Angina Pectoris / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D011446:Prospective Studies; D006113:United Kingdom
D002317:Cardiovascular Agents