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Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis

Aziz Rezapour1, Nader Tavakoli2, Sadaf Akbari2

  • 1Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Medical Journal of the Islamic Republic of Iran
|January 27, 2021
PubMed

Insights

Percutaneous coronary intervention (PCI) is more cost-effective for reducing mortality and improving quality of life in ischemic heart disease than medical therapy (MT). However, MT may be more cost-effective overall, presenting a complex treatment decision.

Area of Science:

  • Cardiology
  • Health Economics

Background:

  • Ischemic heart disease (IHD) presents acute and chronic forms, managed via revascularization or medical therapy.
  • Evaluating the economic burden of IHD treatments is crucial for healthcare policy.
  • This study compares the cost-effectiveness of medical therapy (MT) versus percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease.
  • To compare the effectiveness and cost-effectiveness of MT and PCI for IHD management.

Main Methods:

  • A two-step approach: systematic review/meta-analysis for effectiveness and societal cost-effectiveness analysis.
  • Markov cohort simulation and sensitivity analyses were employed.
  • Data analysis utilized RewMan v5 and TreeAge software.

Main Results:

  • PCI showed a non-significant trend towards lower mortality (OR 2.23, p=0.02) and similar quality of life (OR 0.91, p=0.34) compared to MT.
  • The incremental cost-effectiveness ratio (ICER) for improving quality of life was $25,320.11, and for mortality reduction was $562,6691.
  • Sensitivity analyses indicated model robustness.

Conclusions:

  • PCI demonstrates greater cost-effectiveness in reducing mortality and enhancing quality of life for IHD.
  • Medical therapy (MT) may present a more cost-effective strategy overall.
  • Findings aid health policymakers and clinicians in IHD treatment decisions.

Keywords:
Cost-effectiveness analysisIschemic heart diseaseMedical therapyPercutaneous coronary intervention

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