title: Annual cost of stable coronary artery disease in France: A modeling study.
abstract: BACKGROUND
  Few studies have analyzed the cost of treatment of chronic angina pectoris, especially in European countries.
  
  
  OBJECTIVE
  To determine, using a modeling approach, the cost of care in 2012 for 1year of treatment of patients with stable angina, according to four therapeutic options: optimal medical therapy (OMT); percutaneous coronary intervention with bare-metal stent (PCI-BMS); PCI with drug-eluting stent (PCI-DES); and coronary artery bypass graft (CABG).
  
  
  METHODS
  Six different clinical scenarios that could occur over 1year were defined: clinical success; recurrence of symptoms without hospitalization; myocardial infarction (MI); subsequent revascularization; death from non-cardiac cause; and cardiac death. The probability of a patient being in one of the six clinical scenarios, according to the therapeutic options used, was determined from a literature search. A direct medical cost for each of the therapeutic options was calculated from the perspective of French statutory health insurance.
  
  
  RESULTS
  The annual costs per patient for each strategy, according to their efficacy results, were, in our models, €1567 with OMT, €5908 with PCI-BMS, €6623 with PCI-DES and €16,612 with CABG. These costs were significantly different (P<0.05). A part of these costs was related to management of complications (recurrence of symptoms, MI and death) during the year (between 3% and 38% depending on the therapeutic options studied); this part of the expenditure was lowest with the CABG therapeutic option.
  
  
  CONCLUSIONS
  OMT appears to be the least costly option, and, if reasonable from a clinical point of view, might achieve appreciable savings in health expenditure.
authors.affiliation: AP-HP, hôpital européen Georges-Pompidou, Pharmacie, 20, rue Leblanc, 75015 Paris, France. Electronic address: thibaut.caruba@egp.aphp.fr.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Caruba
authors.affiliation: AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France; Inserm, ECEVE, U1123, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Zarca
authors.affiliation: AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cadier
authors.affiliation: CHU Nancy-Brabois, Institut Lorrain du cœur et des vaisseaux, cardiologie, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: AP-HP, hôpital Ambroise-Paré, cardiologie, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
authors.affiliation: AP-HP, hôpital européen Georges-Pompidou, Pharmacie, 20, rue Leblanc, 75015 Paris, France; Inserm, centre de recherche des cordeliers, UMR 1138, équipe 22, 75006 Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sabatier
authors.affiliation: AP-HP, hôpital européen Georges-Pompidou, cardiologie, 20, rue Leblanc, 75015 Paris, France; Université René-Descartes, faculté de médecine, 15, rue de l'École-de-médecine, 75006 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002423:Cause of Death; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics; D005260:Female; D005602:France; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008670:Metals / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D011474:Prosthesis Design; D012008:Recurrence; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D008670:Metals
keywords: Angor stable; Coronary artery disease; Costing study; Coûts; Drug; Models; Modélisation; Médicaments; Revascularisation; Revascularization