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
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.
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.
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.
Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups
|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) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds)
|Depositing User:||York RAE Import|
|Date Deposited:||15 May 2009 13:59|
|Last Modified:||18 Jun 2015 17:27|
|Publisher:||Elsevier Science B.V.|