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Economic evaluation of the impact of nicorandil in angina (IONA) trial
  1. A Walker1,
  2. J McMurray2,
  3. S Stewart3,
  4. W Berger4,
  5. A D McMahon1,
  6. H Dargie2,
  7. K Fox5,
  8. S Hillis2,
  9. N J K Henderson1,
  10. I Ford1
  1. 1Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
  2. 2Department of Cardiology, Western Infirmary, Glasgow, Scotland
  3. 3Division of Health Sciences, University of South Australia, Adelaide, Australia
  4. 4Health Economics Division, Merck KGaA, Darmstadt, Germany
  5. 5Department of Cardiology, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Dr A Walker
    Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow G12 8QQ, UK; andreww{at}


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.

  • 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
  • angina
  • nicorandil
  • randomised controlled trial
  • economic evaluation

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  • Competing interests: The Robertson Centre was also funded to administer the IONA randomised clinical trial.