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Cost-effectiveness of an invasive strategy in unstable coronary artery disease: results from the FRISC II invasive trial
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-9375-5087
Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2608-2062
2002 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 1, 31-40 p.Article in journal (Refereed) Published
Abstract [en]

Aims The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs.

Methods and Results A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1·7% absolute reduction in deaths and a 3·7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3·9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P<0·001). The incermental cost-effective ratio for choosing the invasive instead of the non-invasive strategy is SEK 1 404 000 per avoided death and SEK 645 000 per avoided death or myocardial infarction

Conclusion The high cost at the beginning of the invasive strategy is substantial. The clinical results of the FRISC II study provided evidence that the invasive strategy reduces the rate of death and myocardial infarction in patients with unstable coronary artery disease. For policy discussions concerning whether or not to implement the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.

Place, publisher, year, edition, pages
2002. Vol. 23, no 1, 31-40 p.
Keyword [en]
Unstable angina, non-Q wave myocardial infarction, unstable coronary artery disease, costs, cost-effectiveness, revascularization
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26279DOI: 10.1053/euhj.2001.2695Local ID: 10793OAI: oai:DiVA.org:liu-26279DiVA: diva2:246827
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Treatment strategies in unstable coronary artery disease: economic and quality of life evaluations
Open this publication in new window or tab >>Treatment strategies in unstable coronary artery disease: economic and quality of life evaluations
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the past few decades two treatment strategies have evolved for patients with unstable coronary artery disease (UCAD). The non-invasive strategy uses clinical investigations and non-invasive stress tests to identify patients who need diagnostic catheterisation. The early invasive strategy uses coronary catheterisation as the diagnostic instrument. The new technologies have consequences not only for the clinical endpoints of death or myocardial infarction (MI), but also in terms of health-related quality of life and costs. The economic evaluations are of great importance due to the high incidence of the disease and high short-term costs of the invasive strategy. The early costly intervention may prevent later complications and thereby partly or completely offset the higher initial treatment costs. Even if longterm costs remain higher, they can be justified by improved survival or quality of life. Such clinical effects in the long-term follow-up need to be seen in relation to the cost of the strategy. In a prospective Scandinavian multi centre trial we examined 3489 patients with UCAD. The purpose of this thesis was to study the treatment strategies in UCAD with respect to cost-effectiveness and patients' health-related quality of life. This purpose was divided into four aims:

The first aim was to evaluate the cost-effectiveness of extended treatment with the low-molecular-weight heparin dalteparin. 2267 patients were randomised. The incremental cost-effectiveness ratio for administering dalteparin treatment for one month was SEK 30,300 per avoided death or MI. Since the resources for early intervention are limited in many countries, extended dalteparin treatment for up to one month is a cost-effective bridge to invasive intervention.

The second aim was to evaluate the short-term costs and cost-effectiveness of the invasive strategy compared to the non-invasive strategy. A total of 2457 patients were randomised. The results were analysed in a societal perspective. The difference in mean total costs after one year was SEK 23,900 (p < 0.001), favouring the non-invasive strategy. The incremental cost-effectiveness ratio for choosing the invasive instead of the non-invasive strategy was SEK 645,000 per avoided death or MI. The high cost at the beginning of the invasive strategy was substantial. For policy discussions concerning implementing the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.

The third aim was to evaluate the patients' health-related quality of life with respect to the strategies. We used two questionnaires, the generic Short Form 36 (SF-36) and the disease-specific Angina Pectoris Quality of Life Questionnaire (APQLQ), at randomisation and after three, six and 12 months of followup. The invasively treated group showed a significantly better health-related quality of life at the threeand six-month follow-ups (p < 0.01) than the non-invasively treated group. These differences remained at the 12-month follow-up. The disease-specific quality of life results were similar.

The fourth aim was to evaluate the long-term cost-effectiveness and cost-utility of these strategies. Results were analysed in both a societal and a health care provider perspective. The difference in mean total cost SEK 11,400 was not statistically significant. The estimated cost per quality adjusted life year (QALY) gained for the invasive strategy, based on within trial results and projected life expectancy, was SEK 22,900. These results were consistent in most subgroups. The estimated cost per life year gained was SEK 57,700. Compared to other accepted treatments in the cardiovascular field, the cost per QALY gained is very low.

In summary, this thesis shows that the early invasive treatment strategy for patients with UCAD promotes health-related quality of life and is highly cost-effective when compared to many other interventions in the cardiovascular field and should therefore be recommended.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. 176 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 811
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27497 (URN)12151 (Local ID)91-7373-499-3 (ISBN)12151 (Archive number)12151 (OAI)
Public defence
2003-10-17, Elsa Brändströmsa sal, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-11Bibliographically approved

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Janzon, MagnusLevin, Lars-ÅkeSwahn, Eva

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