The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial.
BACKGROUND
Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.


OBJECTIVE
The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.


METHODS
Decision-analytic model based on randomised clinical trial data.


METHODS
Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.


METHODS
Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients' lifetimes within the decision-analytic model.


RESULTS
The mean incremental cost per QALY gained for an early interventional strategy was approximately 55,000 pounds sterling, 22,000 pounds sterling and 12,000 pounds sterling for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of 20,000 pounds sterling per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.


CONCLUSIONS
An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.
Henriksson
M
M
Centre for Health Economics, University of York, UK. martin.henriksson@ihs.liu.se
Epstein
D M
DM
Palmer
S J
SJ
Sculpher
M J
MJ
Clayton
T C
TC
Pocock
S J
SJ
Henderson
R A
RA
Buxton
M J
MJ
Fox
K A A
KA
D054058:Acute Coronary Syndrome / Q000191:economics* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000191:economics / Q000628:therapy; D017023:Coronary Angiography / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D003365:Costs and Cost Analysis; D003925:Diabetic Angiopathies / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic