Is an invasive interventional strategy of value in non-ST-elevation acute coronary syndromes?
Cost-effectiveness can be a helpful indicator of therapeutic value and is an important consideration when determining whether to use an invasive strategy in patients with non-ST-elevation (NSTE) acute coronary syndromes. In an economic analysis using results from RITA 3, Henriksson et al. found that an invasive strategy was not cost-effective in patients with low-risk disease, but was cost-effective for patients with high-risk disease and of equivocal cost-effectiveness in patients with intermediate-risk disease. This finding is consistent with those of other studies, especially FRISC II and TACTICS-TIMI 18, which found an invasive strategy to be cost-effective in patients with biomarker-positive NSTE myocardial infarction. An invasive strategy should, therefore, be considered for treatment of patients with high-risk NSTE myocardial infarction. Although available data are not based on the latest technology, another trial in this area would be difficult to conduct and of questionable ethics.
Christiana Care Health System, Newark, DE 19718, USA. wweintraub@christianacare.org
William S
WS
Weintraub
D054058:Acute Coronary Syndrome / Q000191:economics* / Q000401:mortality / Q000628:therapy; D006328:Cardiac Catheterization / Q000191:economics; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use; D017023:Coronary Angiography / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009203:Myocardial Infarction / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000191:economics*; D018579:Patient Selection; D018570:Risk Assessment; D016896:Treatment Outcome
D002317:Cardiovascular Agents