Management of non-ST-elevation acute coronary syndromes: how cost-effective are glycoprotein IIb/IIIA antagonists in the UK National Health Service?
BACKGROUND
The glycoprotein IIb/IIIa antagonists (GPAs) represent a new class of drugs to prevent platelet aggregation in the acute treatment of non-ST-elevation acute coronary syndromes (NSTE-ACS). Systematic reviews have identified serious limitations in published cost-effectiveness analyses, including a lack of UK-specific studies and an absence of studies comparing different protocols for the use of GPAs.


METHODS
A model was developed to assess the cost effectiveness of a variety of protocols employing GPAs for patients presenting with NSTE-ACS in the UK. The perspective of the UK National Health Service was adopted, with outcomes in terms of quality-adjusted life-years (QALYs). Four treatment strategies were evaluated: GPAs as part of initial medical management (Strategy 1); GPAs in patients with planned percutaneous coronary interventions (PCIs; Strategy 2); GPAs as an adjunct to the PCI procedure (Strategy 3); and no GPAs (Strategy 4). Baseline event rates and costs were taken from a UK observational study of ACS patients and relative risk reductions from GPAs were taken from a meta analysis of trials. Long-term costs and QALYs were estimated using data from a UK longitudinal study.


RESULTS
The most cost-effective use of GPAs is likely to be Strategy 1, with an incremental cost per QALY gained of between pound4605 to pound10,343. Focusing this use of GPAs only on the subgroup of patients at high risk appears to represent the most cost-effective use of NHS resources.


CONCLUSIONS
Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups.
Palmer
Stephen
S
Centre for Health Economics, University of York, Heslington, UK. sjp21@york.ac.uk
Sculpher
Mark
M
Philips
Zoe
Z
Robinson
Mike
M
Ginnelly
Laura
L
Bakhai
Ameet
A
Abrams
Keith
K
Cooper
Nicola
N
Packham
Chris
C
Alfakih
Khaled
K
Hall
Alistair
A
Gray
David
D
D003327:Coronary Disease / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D019057:Quality-Adjusted Life Years; D012306:Risk; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex