title: A multi-country health economic evaluation of highly concentrated N-3 polyunsaturated fatty acids in secondary prevention after myocardial infarction.
abstract: BACKGROUND
  Patients who survive an acute myocardial infarction (MI) are at an increased risk of subsequent major cardiovascular events and (often sudden) cardiac death. The use of highly concentrated and purified omega-3 polyunsaturated fatty acids (n-3 PUFAs), in addition to standard secondary prevention after MI, results in a significant reduction in the risk of sudden death versus no n-3 PUFAs. This study assessed the cost effectiveness of adding n-3 PUFAs to the current secondary prevention treatment versus standard prevention alone after acute MI in five countries: Australia, Belgium, Canada, Germany and Poland.
  
  
  METHODS
  Based on the clinical outcomes of GISSI-P (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico - Prevenzione) [MI, stroke, revascularisation rate and mortality], a decision model was built in DataProtrade mark. The implications of adding n-3 PUFAs to standard treatment in patients aged 59 years with a recent history of MI were analysed from the healthcare payer's perspective. The time horizon was 3.5 years (identical to GISSI-Prevenzione) but the effects on life expectancy through avoidance of cardiac events were calculated lifelong. Event costs were based on literature data. Life expectancy data for survivors of cardiac disease were taken from the Saskatchewan database and then adjusted by country. Results are expressed as extra cost (Euro) per life-year gained (LYG). Annual discounting of 5% was applied to health effects and costs.
  
  
  RESULTS
  Treatment with highly concentrated n-3 PUFAs yielded between 0.261 (Poland) and 0.284 (Australia) LYG, at an additional cost of 787 Euros(Canada) to 1,439 Euros(Belgium). The ICER varied between 2,788 Euros(Canada) and 5,097 Euros(Belgium) per LYG. Sensitivity analyses on effectiveness, cost of complications and discounting proved the robustness of the results. A second-order Monte Carlo simulation based on the 95% confidence intervals obtained from GISSI-P suggests that highly concentrated n-3 PUFAs are cost effective in 93% of simulations in Poland and in >98% of simulations in the other countries, assuming the country-specific societal willingness-to-pay threshold. Total costs were considerably increased by including healthcare costs incurred during the remaining life-years, but this had no impact on the ICER-based treatment recommendation.
  
  
  CONCLUSIONS
  Adding highly concentrated n-3 PUFAs to standard treatment in the secondary prevention of MI appears to be cost effective versus standard treatment alone in the five countries studied.
authors.affiliation: Health Economics and Outcomes Research, Unit of IMS Health, Brussels, Belgium. MLamotte@be.imshealth.com
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Pawel
authors.initials: P
authors.lastname: Kawalec
authors.forename: York
authors.initials: Y
authors.lastname: Zoellner
mesh_terms: D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D015525:Fatty Acids, Omega-3 / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D009010:Monte Carlo Method; D009203:Myocardial Infarction / Q000517:prevention & control*
chemical_list: D015525:Fatty Acids, Omega-3