Potential economic consequences of a cardioprotective agent for patients with myocardial infarction: modelling study

Abstract

ObjectiveTo investigate the cost-effectiveness of a hypothetical cardioprotective agent used to reduce infarct size in patients undergoing percutaneous coronary intervention (PCI) after anterior ST-elevation myocardial infarction.MethodsDesign: A cost-utility analysis using a Markov model. Setting: The National Health Service in the UK. Patients: Patients undergoing PCI after anterior ST-elevation myocardial infarction. Interventions: A cardioprotective agent given at the time of reperfusion compared to no cardioprotection. We assumed the cardioprotective agent (given at the time of reperfusion) would reduce the risk and severity of heart failure (HF) after PCI and the risk of mortality after PCI (with a relative risk ranging from 0.6 to 1). The costs of the cardioprotective agent were assumed to be in the range £1000–4000. Main outcome measures: The incremental costs per quality-adjusted life-year (QALY) gained, using 95% CIs from 1000 simulations.ResultsIncremental costs ranged from £933 to £3820 and incremental QALYs from 0.04 to 0.38. The incremental cost-effectiveness ratio (ICER) ranged from £3311 to £63 480 per QALY gained. The results were highly dependent on the costs of a cardioprotective agent, patient age, and the relative risk of HF after PCI. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 71% of the simulations.ConclusionsA cardioprotective agent that can reduce the risk of HF and mortality after PCI has a high chance of being cost-effective. This chance depends on the price of the agent, the age of the patient and the relative risk of HF after PCI.

Joint Cardioprotective Effect of Vitamin C and Other Antioxidants against Reperfusion Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…Although, in recent years, there have been several studies on ischemic conditioning (pre- and post-conditioning), they have been disappointing in their clinical application [ 145 ]. Because of this, other ways to achieve cardioprotection have been studied, and a cost-effective study has established the positive economic consequences of the use of a cardioprotective therapy in patients with AMI involving endogenous cardioprotection strategies, beta-blocker therapy, or even mitochondria-targeted cardioprotection strategies [ 11 , 145 , 146 ], which makes it a very striking strategy not only for its effects at the tissue level. According to Davidson et al, a multitarget cardioprotective therapy is defined as the additive or synergistic cardioprotective effects of multiple agents or interventions directed to distinct targets [ 11 ] and that, in the future, this option should be considered as a parallel treatment to the restoration of blood flow after ischemia.…”

Sodium Nitrite–Mediated Cardioprotection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Cost-Effectiveness Analysis

“…A hypothetical analysis determined that any cardioprotective agent that reduces the risk of HF and mortality after PCI is likely to be cost-effective; however, the likelihood will depend on the price of the agent, age of the study cohort, and the relative risk of HF after PCI. 12 To be cost-effective, the authors calculated that the maximum cost of the therapy should be less than £2500 and the reduction in HF incidence and mortality should be at least 20%. 12 These values are consistent with our data.…”

“…12 To be cost-effective, the authors calculated that the maximum cost of the therapy should be less than £2500 and the reduction in HF incidence and mortality should be at least 20%. 12 These values are consistent with our data. Specifically, we showed that if MACE reduction found in our study with sodium nitrite is replicated in a larger study, then the therapy could cost up to £2006 and remain cost-effective.…”

Time-Series Modeling and Simulation for Comparative Cost-Effective Analysis in Cancer Chemotherapy: An Application to Platinum-Based Regimens for Advanced Non-small Cell Lung Cancer

“…Modeling and simulation (M&S) has been often used in cost-effective analysis for decision-making. 5,11,12) A Markov process model 13,14) has been used for modeling changes in disease conditions in patients, and a typical index such as the incremental cost-effective ratio (ICER) 15) has been used for this purpose. In a Markov model, transition probabilities are estimated from hazard rates of progression free survival (PFS) or overall survival (OS), and a time course profile of PFS or OS is not considered.…”