Costs of an early intervention versus a conservative strategy in acute coronary syndrome.
BACKGROUND
The Randomised Intervention Treatment of unstable Angina (RITA-3) found that non-ST-elevation myocardial infarction and unstable angina patients randomised to routine early arteriography experienced a lower rate of death or myocardial infarction than patients randomised to conservative therapy over a five year period of follow up. This paper uses data from the RITA-3 trial to compare the health service costs of the two strategies.


METHODS
The resource use data included initial arteriography and revascularisation procedures in the early intervention group and subsequently in both groups; in-patient days in hospital for any reason in the first year of follow-up; incidence of myocardial infarction; and cardiac medication.


RESULTS
After five years, the early intervention arm accrued a total mean cost of pound sterling 11,340 (euro 15,592) and the conservative arm a mean of pound sterling 9749(euro 13,405), an additional mean cost in the intervention arm of pound sterling 1591 (95% CI pound sterling 851 to pound sterling 2276) (euro 2188; 95%CI euro 1160 to euro 3228). On average, costs increased with age and were higher in male patients and in patients with severe angina. However, the incremental cost of the intervention strategy was consistent across different patient sub-groups.


CONCLUSIONS
Over a period of 5 years, the initial additional cost of a strategy of early intervention is only partially offset by subsequent interventions in patients managed conservatively.
Epstein
David M
DM
Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK. dme2@york.ac.uk
Sculpher
Mark J
MJ
Clayton
Tim C
TC
Henderson
Rob A
RA
Pocock
Stuart J
SJ
Buxton
Martin J
MJ
Fox
Keith A A
KA
D054058:Acute Coronary Syndrome / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors