White Rose University Consortium logo
University of Leeds logo University of Sheffield logo York University logo

Management of non-ST-elevation acute coronary syndromes: how cost-effective are glycoprotein IIb/IIIA antagonists in the UK National Health Service?

Palmer, S., Sculpher, M., Philips, Z., Robinson, M., Ginnelly, L., Bakhai, A., Abrams, K., Cooper, N., Packham, C., Alfakih, K., Hall, A. and Gray, D. (2005) Management of non-ST-elevation acute coronary syndromes: how cost-effective are glycoprotein IIb/IIIA antagonists in the UK National Health Service? International Journal of Cardiology, 100 (2). pp. 229-240. ISSN 0167-5273

Full text not available from this repository.

Abstract

BAACKGROUND

The glycoprotein IIb/IIIa antagonists (GPAs) represent a new class of drugs to prevent platelet aggregation in the acute treatment of non-ST-elevation acute coronary syndromes (NSTE-ACS). Systematic reviews have identified serious limitations in published cost-effectiveness analyses, including a lack of UK-specific studies and an absence of studies comparing different protocols for the use of GPAs.

METHODS

A model was developed to assess the cost effectiveness of a variety of protocols employing GPAs for patients presenting with NSTE-ACS in the UK. The perspective of the UK National Health Service was adopted, with outcomes in terms of quality-adjusted life-years (QALYs). Four treatment strategies were evaluated: GPAs as part of initial medical management (Strategy 1); GPAs in patients with planned percutaneous coronary interventions (PCIs; Strategy 2); GPAs as an adjunct to the PCI procedure (Strategy 3); and no GPAs (Strategy 4). Baseline event rates and costs were taken from a UK observational study of ACS patients and relative risk reductions from GPAs were taken from a meta analysis of trials. Long-term costs and QALYs were estimated using data from a UK longitudinal study.

RESULTS

The most cost-effective use of GPAs is likely to be Strategy 1, with an incremental cost per QALY gained of between £4605 to £10,343. Focusing this use of GPAs only on the subgroup of patients at high risk appears to represent the most cost-effective use of NHS resources.

CONCLUSIONS

Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Health Sciences (Leeds)
Depositing User: York RAE Import
Date Deposited: 15 May 2009 13:59
Last Modified: 04 Oct 2010 10:28
Published Version: http://dx.doi.org/10.1016/j.ijcard.2004.08.042
Status: Published
Publisher: Elsevier Science B.V.
Identification Number: 10.1016/j.ijcard.2004.08.042
URI: http://eprints.whiterose.ac.uk/id/eprint/6347

Actions (repository staff only: login required)