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The Cost-Effectiveness of an Early Interventional Strategy in Non-ST-Elevation Acute Coronary Syndrome Based on the RITA 3 Trial
  1. Martin Henriksson (martin.henriksson{at}ihs.liu.se)
  1. Centre for Medical Technology Assessment, Sweden
    1. David M Epstein (dme2{at}york.ac.uk)
    1. University of York, United Kingdom
      1. Stephen J Palmer (sjp21{at}york.ac.uk)
      1. University of York, United Kingdom
        1. Mark J Sculpher (mjs23{at}york.ac.uk)
        1. University of York, United Kingdom
          1. Tim C Clayton (tim.clayton{at}lshtm.ac.uk)
          1. London School of Hygiene & Tropical Medicine, United Kingdom
            1. Stuart J Pocock (stuart.pocock{at}lshtm.ac.uk)
            1. London School of Hygiene & Tropical Medicine, United Kingdom
              1. Robert A Henderson (roberthenderson{at}ntlworld.com)
              1. Nottingham City Hospital, United Kingdom
                1. Martin J Buxton (martin.buxton{at}brunel.ac.uk)
                1. Brunel University, United Kingdom
                  1. Keith A A Fox (k.a.a.fox{at}ed.ac.uk)
                  1. University of Edinburgh, United Kingdom

                    Abstract

                    Background Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.

                    Objective The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective. Design: Decision-analytic model based on randomised clinical trial data.

                    Main outcome measures Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.

                    Methods Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients' lifetimes within the decision-analytic model.

                    Results The mean incremental cost per QALY gained for an early interventional strategy was approximately GBP55,000, GBP22,000 and GBP12,000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of GBP20,000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.

                    Conclusion An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.

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