Potential Costs and Effects of the National Service Framework for Coronary Heart Disease in the UK

Venanzio Vella ()

PharmacoEconomics, 2003, vol. 21, issue 1, 49-60

Abstract: Objective: To estimate the costs and effect of implementing the National Service Framework for Coronary Heart Disease (CHD) in the UK. Design: Decision trees were built on the results from randomised controlled trials on improving coronary revascularisation. All costs were presented in UK pounds (1997 values). Patients: Each year 6600 new patients with CHD are expected to require revascularisation in the UK. Interventions: The new patients would be equally divided into those undergoing coronary artery bypass grafting (CABG) and those undergoing a percutaneous coronary intervention (PCI) i.e., percutaneous transluminal angioplasty (PCTA). PTCA could be administered with or without abciximab (a glycoprotein IIb/IIIa receptor antagonist), stent, or stent plus abciximab (stent+). Results: CABG/stent alone has an incremental cost of more than £115 489 per additional quality-adjusted life-year (QALY) gained compared with CABG/PTCA+. This high incremental cost is not attractive because if CABG/stent would be added to abciximab(CABG/stent+) its incremental cost-effectiveness ratio would be £2529 per extra QALY compared with CABG/stent. Therefore, the debate should not be limited to the issue of stents but it should focus on the need for administering abciximab in addition to stent. The 5-year direct costs of implementing such a strategy in the UK is expected to be £50.6 million (1997 values). Conclusions: Abciximab and probably any glycoprotein IIb/IIIa receptor antagonists should be added to any PCI, especially if stents are used. Copyright Adis International Limited 2003

Date: 2003
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DOI: 10.2165/00019053-200321010-00004

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