title: Potential economic consequences of a cardioprotective agent for patients with myocardial infarction: modelling study.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of a hypothetical cardioprotective agent used to reduce infarct size in patients undergoing percutaneous coronary intervention (PCI) after anterior ST-elevation myocardial infarction.
  
  
  METHODS
  
  
  
  METHODS
  A cost-utility analysis using a Markov model.
  
  
  METHODS
  The National Health Service in the UK.
  
  
  METHODS
  Patients undergoing PCI after anterior ST-elevation myocardial infarction.
  
  
  METHODS
  A cardioprotective agent given at the time of reperfusion compared to no cardioprotection. We assumed the cardioprotective agent (given at the time of reperfusion) would reduce the risk and severity of heart failure (HF) after PCI and the risk of mortality after PCI (with a relative risk ranging from 0.6 to 1). The costs of the cardioprotective agent were assumed to be in the range £1000-4000.
  
  
  METHODS
  The incremental costs per quality-adjusted life-year (QALY) gained, using 95% CIs from 1000 simulations.
  
  
  RESULTS
  Incremental costs ranged from £933 to £3820 and incremental QALYs from 0.04 to 0.38. The incremental cost-effectiveness ratio (ICER) ranged from £3311 to £63 480 per QALY gained. The results were highly dependent on the costs of a cardioprotective agent, patient age, and the relative risk of HF after PCI. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 71% of the simulations.
  
  
  CONCLUSIONS
  A cardioprotective agent that can reduce the risk of HF and mortality after PCI has a high chance of being cost-effective. This chance depends on the price of the agent, the age of the patient and the relative risk of HF after PCI.
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Talitha I
authors.initials: TI
authors.lastname: Verhoef
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK Barts Health NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D000367:Age Factors; D000368:Aged; D002316:Cardiotonic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D002316:Cardiotonic Agents