Economic evaluation of the impact of nicorandil in angina (IONA) trial.
OBJECTIVE
To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit.


METHODS
Cost effectiveness analysis.


METHODS
Based on results of the IONA (impact of nicorandil on angina) trial.


METHODS
Patients with angina fulfilling the entry criteria for the IONA trial.


METHODS
In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone.


METHODS
Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial.


RESULTS
The net cost for each additional IONA trial end point averted was -5 pounds sterling (-7 euros). The net cost for each case of acute coronary syndrome averted was -8 pounds sterling (-12 euros). The net cost for each event-free survivor was -5 pounds sterling (-7 euros). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to 567 pounds sterling (835 euros), 886 pounds sterling (1305 euros), and 516 pounds sterling (760 euros), respectively.


CONCLUSIONS
A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably.
Walker
A
A
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland. andreww@stats.gla.ac.uk
McMurray
J
J
Stewart
S
S
Berger
W
W
McMahon
A D
AD
Dargie
H
H
Fox
K
K
Hillis
S
S
Henderson
N J K
NJ
Ford
I
I
D000787:Angina Pectoris / Q000188:drug therapy* / Q000191:economics; D002318:Cardiovascular Diseases / Q000191:economics / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D005767:Gastrointestinal Diseases / Q000191:economics / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D020108:Nicorandil / Q000191:economics / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000191:economics / Q000627:therapeutic use*
D014665:Vasodilator Agents; D020108:Nicorandil