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Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial
Michelle Samuel1, Jean-Claude Tardif1, Paul Khairy1
1Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada.
Insights
Low-dose colchicine therapy after myocardial infarction (MI) is cost-effective. This treatment reduces cardiovascular events and healthcare costs, proving to be an economically dominant strategy for post-MI patients.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- The Colchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated that low-dose colchicine reduces major adverse cardiovascular events in patients post-myocardial infarction (MI).
- Standard-of-care therapy for post-MI patients often involves multiple medications, and the economic implications of adding novel treatments require thorough evaluation.
Purpose of the Study:
- To assess the cost-effectiveness of low-dose colchicine therapy compared to placebo in patients following a myocardial infarction (MI).
- To evaluate both the in-trial and lifetime economic impact of adding colchicine to standard post-MI care.
Main Methods:
- A multistate Markov model was developed using efficacy and safety data from the COLCOT trial.
- The model incorporated Canadian healthcare costs and utilities, including all components of the primary outcome, non-cardiovascular deaths, and pneumonia.
- Incremental Cost-Effectiveness Ratios (ICERs) were calculated for the trial period (24 months) and lifetime (20 years) using a deterministic approach.
Main Results:
- Over the trial period, colchicine decreased per-patient costs by 47% (from $502 to $265 CAD) and increased quality-adjusted life years (QALYs) from 1.30 to 1.34.
- Lifetime analysis showed further cost reductions (69%) and QALY gains (from 8.82 to 11.68) with colchicine therapy.
- Both in-trial and lifetime ICERs indicated that colchicine therapy was a dominant strategy.
Conclusions:
- Cost-effectiveness analyses demonstrate that adding colchicine to standard-of-care therapy post-MI is an economically dominant strategy.
- Colchicine therapy after myocardial infarction not only improves clinical outcomes but also generates significant cost savings.
Aims:
In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy.
Methods And Results:
A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy.
Conclusion:
Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
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