title: Cost-effectiveness of ranolazine added to standard-of-care treatment in patients with chronic stable angina pectoris.
abstract: Ranolazine has been shown to decrease angina pectoris frequency and nitroglycerin consumption. We assessed the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ≥3 attacks/week. A Markov model utilizing a societal perspective, a 1-month cycle length, and a 1-year time horizon was developed to estimate costs (2013 US$) and quality-adjusted life years (QALYs) for patients receiving and not receiving ranolazine. Patients entered the model in 1 of the 4 angina frequency health states based upon Seattle Angina Questionnaire angina frequency (SAQAF) scores (100=no; 61 to 99=monthly; 31 to 60=weekly; and 0 to 30=daily angina) and were allowed to transition between states or to death based upon probabilities derived from the Efficacy of Ranolazine in Chronic Angina and other studies. Patients not responding to ranolazine in month 1 (not improving ≥1 SAQAF health state) were assumed to discontinue ranolazine and behave like SoC patients. Ranolazine patients lived a mean of 0.700 QALYs at a cost of $15,661. Those not receiving ranolazine lived 0.659 QALYs and at a cost of $14,321. The incremental cost-effectiveness ratio (ICER) for the addition of ranolazine was $32,682/QALY. The ICER was most sensitive to ranolazine cost but only exceeded $50,000/QALY when the cost of ranolazine increased >32% above base case. The ICER remained <$50,000/QALY when indirect costs were excluded, and mortality rates were assumed equivalent between SAQAF health states. Monte Carlo simulation found ranolazine cost-effective in 97% of 10,000 iterations at a $50,000/QALY willingness-to-pay threshold. In conclusion, ranolazine added to SoC is cost-effective in patients with weekly or daily angina.
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut; Department of Pharmacy Practice, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Storrs and Hartford, Connecticut.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Kohn
authors.affiliation: Department of Cardiology, Hartford Hospital, Hartford, Connecticut.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Parker
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut; Department of Pharmacy Practice, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Storrs and Hartford, Connecticut.
authors.forename: Brendan L
authors.initials: BL
authors.lastname: Limone
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut; Department of Pharmacy Practice, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Storrs and Hartford, Connecticut. Electronic address: craig.coleman@hhchealth.org.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000083:Acetanilides / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D060050:Angina, Stable / Q000188:drug therapy* / Q000191:economics; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D016527:Drug Costs; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000069458:Ranolazine; D059039:Standard of Care / Q000191:economics*; D014481:United States
chemical_list: D000083:Acetanilides; D004791:Enzyme Inhibitors; D010879:Piperazines; D000069458:Ranolazine