Assessing the value of newer pharmacologic agents in non-ST elevation patients: a decision support system application

Newer pharmacologic agents have demonstrated significant clinical and economic benefit in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients. However, the higher costs of these agents may prohibit their use in lower-risk coronary artery disease (CAD) populations. We developed a decision support system (DSS) to determine the level of clinical effectiveness these newer agents must exhibit to be either cost-neutral or cost-effective in non-ST elevation patients. Our DSS evaluated six month cumulative costs, increased years of life saved (YOLS), and lifetime cost-effectiveness. We found that these therapies can cost as much as $1500 and be cost-neutral at six months if they reduce the composite endpoint of death, myocardial infarction (MI), or revascularization by 15%, and they may cost as much as $3000 and be cost-effective if they reduce this endpoint by 10%.