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Costs of an early intervention versus a conservative strategy in acute coronary syndrome
David M Epstein1, Mark J Sculpher, Tim C Clayton
1Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK. dme2@york.ac.uk
Insights
Early arteriography for unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI) increases healthcare costs. While effective in reducing adverse events, the higher initial cost of early intervention is only partially offset by later savings in conservative management strategies.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Clinical Trials
Background:
- The Randomised Intervention Treatment of unstable Angina (RITA-3) trial demonstrated that early arteriography reduced death or myocardial infarction in unstable angina and NSTEMI patients compared to conservative therapy.
- This study analyzes the health service costs associated with these two management strategies.
Purpose of the Study:
- To compare the health service costs of routine early arteriography versus conservative therapy for unstable angina and NSTEMI patients.
- To evaluate the long-term economic implications of early invasive cardiac procedures.
Main Methods:
- Resource utilization data from the RITA-3 trial were analyzed.
- Included: initial arteriography, revascularization, inpatient days, myocardial infarction incidence, and cardiac medication use over five years.
Main Results:
- The early intervention group incurred a mean cost of £11,340 over five years, versus £9,749 in the conservative group, an incremental cost of £1,591.
- Costs were higher with increasing age, in males, and with severe angina, but the incremental cost of early intervention remained consistent across subgroups.
Conclusions:
- The initial higher cost of an early intervention strategy for UA/NSTEMI is only partially offset by subsequent interventions in conservatively managed patients over a five-year period.
- Early arteriography represents a significant, though clinically beneficial, additional health service cost.
Background:
The Randomised Intervention Treatment of unstable Angina (RITA-3) found that non-ST-elevation myocardial infarction and unstable angina patients randomised to routine early arteriography experienced a lower rate of death or myocardial infarction than patients randomised to conservative therapy over a five year period of follow up. This paper uses data from the RITA-3 trial to compare the health service costs of the two strategies.
Methods:
The resource use data included initial arteriography and revascularisation procedures in the early intervention group and subsequently in both groups; in-patient days in hospital for any reason in the first year of follow-up; incidence of myocardial infarction; and cardiac medication.
Results:
After five years, the early intervention arm accrued a total mean cost of pound sterling 11,340 (euro 15,592) and the conservative arm a mean of pound sterling 9749(euro 13,405), an additional mean cost in the intervention arm of pound sterling 1591 (95% CI pound sterling 851 to pound sterling 2276) (euro 2188; 95%CI euro 1160 to euro 3228). On average, costs increased with age and were higher in male patients and in patients with severe angina. However, the incremental cost of the intervention strategy was consistent across different patient sub-groups.
Conclusion:
Over a period of 5 years, the initial additional cost of a strategy of early intervention is only partially offset by subsequent interventions in patients managed conservatively.
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