© 2003 by BMJ Publishing Group & British Cardiac Society
EDITORIAL
The primacy of clinical effectiveness for cost effectiveness analysis
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Correspondence to:
Correspondence to:
Eric J Topol MD, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA;
topole@ccf.org
Cost effectiveness analysis has increasingly emerged as a means of evaluating new treatments with superior clinical outcomes but increased cost compared with the standard therapy
Keywords: low molecular weight heparin; acute coronary syndrome; cost effectiveness analysis
Abbreviations: ACS, acute coronary syndrome; CEA, cost effectiveness analysis; FRAX.I.S., fraxiparine in ischaemic syndrome; FRISC, Fragmin and fast revascularization during instability in coronary artery disease; LMWH, low molecular weight heparin; MCO, managed care organisation; MI, myocardial infarction
| The first 150 words of the full text of this article appear below. |
Despite the many advances in cardiovascular therapeutics over the last two decades, the incidence of death or myocardial infarction in the six months following clinical presentation with acute coronary syndromes (ACS) (excluding ST elevation myocardial infarction) remains unacceptably high at 12–15% (fig 1
).1 Most ACS trials have focused on reducing ischaemic events during the in-hospital treatment phase (usually less than one week). However, the recognition that 40% of all deaths and myocardial infarctions (MI) in the six months after presentation with ACS occur beyond the seventh day has prompted the search for treatments specifically directed at decreasing ischaemic events beyond the acute treatment phase.
[in a new window] Figure 1 Incidence of death, myocardial infarction (MI), and the composite of death/MI at various time points from presentation with acute coronary syndromes in patients enrolled in the PRISM-PLUS trial.1
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Several key observations have suggested the coagulation cascade should be an attractive target for such treatments: the
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