Related Experiment Videos
Costs and effectiveness of using coumarins before, during and after coronary angioplasty
Jurrien M ten Berg1, Johannas C Kelder, Thys H W Plokker
1Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands. jurtenberg@wxs.nl
Insights
Adding coumarin therapy to aspirin before coronary angioplasty significantly reduces cardiac events and is cost-effective. This combination therapy offers improved outcomes and potential savings compared to aspirin alone.
Area of Science:
- Cardiology
- Health Economics
- Pharmacology
Background:
- Coronary angioplasty often involves aspirin therapy.
- Adding coumarins to aspirin therapy in the Balloon Angioplasty and Anticoagulation Study (BAAS) reduced cardiac events but increased bleeding risk.
Purpose of the Study:
- To evaluate the cost-effectiveness of adding coumarin treatment to aspirin therapy for patients undergoing coronary angioplasty.
- To assess the combined impact of cardiac and bleeding events on treatment outcomes and costs.
Main Methods:
- Effectiveness was measured by the occurrence of death, myocardial infarction (MI), stroke, revascularisations, and major bleeding events at one year.
- Direct medical costs were analyzed.
- Cost-effectiveness was determined using probability ellipses to represent uncertainties in costs and effectiveness.
Main Results:
- Aspirin plus coumarins reduced death, MI, or stroke by 1.1% at one year.
- When including revascularisations and major bleeding, the event reduction was 5.0%.
- Coumarin treatment resulted in estimated savings of Euros 235 per patient, with an 85% probability of being cost-saving and a 70-83% probability of being both effective and cost-saving.
Conclusions:
- Coumarin therapy, when added to aspirin before and after coronary angioplasty, is more effective than aspirin alone.
- This combined therapy is also likely to be cost-saving, offering a favorable risk-benefit profile.
Background:
In the Balloon Angioplasty and Anticoagulation Study (BAAS), coumarins added to routine aspirin therapy before coronary angioplasty reduced cardiac events at the cost of a slightly higher risk of bleeding complications.
Objective:
To determine the cost effectiveness of coumarin treatment, based on the occurrence of both cardiac and bleeding events.
Methods:
Effectiveness was measured, applying two definitions, in terms of the number of events occurring at one year. In the first definition, the occurrence of death, myocardial infarction (MI), or stroke was assessed. The second definition also included revascularisations and major bleeding episodes as an event. Costs were limited to direct medical costs. Cost effectiveness was addressed by probability ellipses representing the point estimates and uncertainties surrounding both costs and effectiveness.
Results:
At 1 year, death, MI or stroke occurred 1.1% less often when treating with aspirin plus coumarins rather than aspirin therapy alone. When revascularisations and major bleeding events were also included, the difference was 5.0%. Overall, the additional costs in relation to coumarin treatment were compensated by a reduction in repeat interventions. When including all costs, the savings associated with coumarin treatment were estimated at Euros 235 per patient after 1 year. The probability that coumarins are cost saving was estimated at 0.85. The probability that coumarins combine additional effectiveness with cost savings was estimated at 0.70 when survival free of MI or stroke as an effectiveness measure was considered, and at 0.83 when survival free of MI, stroke, revascularisation or major bleeding was considered.
Conclusion:
Coumarin therapy added to routine aspirin therapy before coronary angioplasty, and continued during follow-up, may not only be considered more effective but also cost saving relative to aspirin therapy alone.