CARDIOVASCULAR MEDICINE

Economic evaluation of the impact of nicorandil in angina (IONA) trial

A Walker¹, J McMurray², S Stewart³, W Berger⁴, A D McMahon¹, H Dargie², K Fox⁵, S Hillis², N J K Henderson¹, I Ford¹

¹ Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
² Department of Cardiology, Western Infirmary, Glasgow, Scotland
³ Division of Health Sciences, University of South Australia, Adelaide, Australia
⁴ Health Economics Division, Merck KGaA, Darmstadt, Germany
⁵ Department of Cardiology, Royal Brompton Hospital, London, UK

Correspondence to:
Correspondence to:
Dr A Walker
Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow G12 8QQ, UK; andreww{at}stats.gla.ac.uk

Objective: To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit.

Design: Cost effectiveness analysis

Setting: Based on results of the IONA (impact of nicorandil on angina) trial.

Patients: Patients with angina fulfilling the entry criteria for the IONA trial

Interventions: In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone.

Main outcome measures: Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial.

Results: The net cost for each additional IONA trial end point averted was –£5 (–7). The net cost for each case of acute coronary syndrome averted was –£8 (–12). The net cost for each event-free survivor was –£5 (–7). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to £567 (835), £886 (1305), and £516 (760), respectively.

Conclusions: A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably.

Abbreviations: CCU, coronary care unit; CHD, coronary heart disease; ICU, intensive care unit; IONA, impact of nicorandil on angina; MI, myocardial infarction; NICE, National Institute for Health and Clinical Excellence

Keywords: angina; nicorandil; randomised controlled trial; economic evaluation

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