Background The use of coronary catheterisation and revascularisation in unstable coronary artery disease (UCAD) varies, which could have important consequences for patients as well as for health care costs. Our objective was to examine the total two-year costs and the long-term cost-effectiveness and cost-utility of these strategies.
Methods All 2457 patients in the FRISC II invasive trial, randomised to an early invasive strategy with coronary catheterisation and revascularisation if appropriate or to a non-invasive strategy with coronary catheterisation only for recurrent ischemic symptoms or a positive stress test, were included in the economic evaluation. The patients' use of health services as well as productivity losses were recorded prospectively. Health state scores were obtained five times during the two-year follow-up. Health effects and costs appearing after two years were modelled.
Findings The mean total cost was Swedish kronor (SEK) 11 386 (£ 850) higher in the invasive group. 1bis difference 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 22 873 (£ 1 707). These results were consistent in most subgroups. The estimated cost per life year gained was SEK 57 651 (£ 4 302). If costs for added life years were included, the cost per QALY was SEK 78 077 (£ 5 827) for invasive strategy.
Interpretation Invasive strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction was shown to be highly cost-effective in the long term.