Potential costs and effects of the National Service Framework for Coronary Heart Disease in the UK

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Interventional Cardiology

Background:

• Coronary Heart Disease (CHD) management in the UK involves revascularization procedures.
• National Service Framework for CHD aims to improve patient outcomes.
• Percutaneous coronary intervention (PCI) with stenting is a common revascularization technique.

Purpose of the Study:

• To estimate the costs and effectiveness of implementing the National Service Framework for CHD in the UK.
• To evaluate the cost-effectiveness of different PCI strategies, including stenting and abciximab use.
• To inform policy decisions regarding CHD treatment in the UK.

Main Methods:

• Decision tree modeling based on randomized controlled trial data for coronary revascularization.
• Cost analysis presented in UK pounds (1997 values).
• Evaluation of strategies including coronary artery bypass grafting (CABG), PCI, stenting, and abciximab (glycoprotein IIb/IIIa receptor antagonist).

Main Results:

• Coronary artery bypass grafting (CABG) with stenting alone has a high incremental cost-effectiveness ratio (>115,489 pounds/QALY) compared to CABG with PCI plus abciximab.
• Adding abciximab to PCI with stenting (CABG/stent+) results in an incremental cost-effectiveness ratio of 2529 pounds per QALY gained.
• The 5-year direct costs for implementing this strategy in the UK are estimated at 50.6 million pounds (1997 values).

Conclusions:

• Abciximab, and likely other glycoprotein IIb/IIIa receptor antagonists, should be administered with PCI, particularly when stents are employed.
• The focus should be on the necessity of abciximab in conjunction with stents, rather than solely on stent use.
• This approach offers a cost-effective strategy for improving CHD patient outcomes in the UK.