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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Stratified medicine using invasive coronary function testing in angina: A cost-effectiveness analysis of the British

R Heggie1, A Briggs2, B Stanley3

  • 1Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, 1 Lilybank Gardens, Glasgow, United Kingdom.

International Journal of Cardiology
|May 16, 2021
PubMed

Insights

An invasive diagnostic procedure (IDP) for patients with no obstructive coronary arteries (INOCA) is cost-effective. This stratified medicine approach improves quality-adjusted life years (QALYs) and is recommended for managing INOCA, especially in women.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Diagnostic Technology

Background:

  • Coronary artery disease (CAD) investigation often involves coronary angiography.
  • A significant proportion of patients with ischemic symptoms have no obstructive coronary arteries (INOCA).
  • INOCA diagnosis and management, including microvascular angina (MVA) and vasospastic angina (VSA), lack clear clinical guidelines and present economic challenges.

Purpose of the Study:

  • To perform a cost-effectiveness analysis of stratified medicine for INOCA management.
  • To evaluate the economic impact of an invasive diagnostic procedure (IDP) targeting specific endotypes in INOCA patients.
  • To inform clinical guidelines and healthcare resource allocation for INOCA.

Main Methods:

  • Cost-effectiveness analysis using data from the CorMicA trial (UK NHS perspective).
  • Intervention: Invasive diagnostic procedure (IDP) for coronary vascular function during angiography.
  • Outcome measures: Mean total cost, QALY gain, and incremental cost-effectiveness ratio (ICER).
  • Statistical analyses: Probabilistic sensitivity and scenario analyses were performed.

Main Results:

  • The incremental cost per QALY gained at 12 months was £4500.
  • The IDP is cost-effective compared to a willingness-to-pay (WTP) threshold of £20,000 per QALY.
  • There is a 96% probability of the IDP being cost-effective at the £20,000 WTP threshold.

Conclusions:

  • The study provides evidence supporting the cost-effectiveness of stratified medicine for INOCA.
  • The findings address an unmet clinical need, particularly for women with INOCA.
  • Implementing IDP can improve patient outcomes and resource utilization in INOCA management.
Abstract

Keywords:
Cost-effectivenessINOCAStratified medicine

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