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.
Weintraub
William S
WS
Christiana Care Health System, Newark, DE 19718, USA. wweintraub@christianacare.org
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