Τίτλος:
A cost-utility analysis of increasing percutaneous coronary intervention
use in elderly patients with acute coronary syndromes in six European
countries
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims Percutaneous coronary intervention reduces mortality in acute
coronary syndrome patients but the cost-utility of increasing its use in
elderly acute coronary syndrome patients is unknown. Methods We assessed
the efficiency of increased percutaneous coronary intervention use
compared to current practice in patients aged >= 75 years admitted for
acute coronary syndrome in France, Germany, Greece, Italy, Portugal and
Spain with a semi-Markov state transition model. In-hospital mortality
reduction estimates by percutaneous coronary intervention use and costs
were derived from the EUROpean Treatment & Reduction of Acute Coronary
Syndromes cost analysis EU project (n = 28,600). Risk of recurrence and
out-of-hospital all-cause mortality were obtained from the Information
System for the Development of Research in Primary Care (SIDIAP) database
from North-Eastern Spain (n = 55,564). In-hospital mortality was
modelled using stratified propensity score analysis. The 8-year acute
coronary syndrome recurrence risk and out-of-hospital mortality were
estimated with a multistate survival model. The scenarios analysed were
to increase percutaneous coronary intervention use among patients with
the highest, moderate and lowest probability of receiving percutaneous
coronary intervention based on the propensity score analysis. Results
France, Greece and Portugal showed similar total costs/1000 individuals
(7.29-11.05 m euro); while in Germany, Italy and Spain, costs were
higher (13.53-22.57 m euro). Incremental cost-utility ratios of
providing percutaneous coronary intervention to all patients ranged from
2262.8 euro/quality adjusted life year gained for German males to 6324.3
euro/quality adjusted life year gained for Italian females. Increasing
percutaneous coronary intervention use was cost-effective at a
willingness-to-pay threshold of 10,000 euro/quality adjusted life year
gained for all scenarios in the six countries, in males and females.
Conclusion Compared to current clinical practice, broadening
percutaneous coronary intervention use in elderly acute coronary
syndrome patients would be cost-effective across different healthcare
systems in Europe, regardless of the selected strategy.
Συγγραφείς:
Forne, C.
Subirana, I
Blanch, J.
Ferrieres, J.
Azevedo,
A.
Meisinger, C.
Farmakis, D.
Tavazzi, L.
Davoli, M. and
Ramos, R.
Brosa, M.
Marrugat, J.
Degano, I. R.
EUROTRACS
Investigators
Περιοδικό:
European Journal of Preventive Cardiology
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
Elderly; acute coronary syndrome; percutaneous coronary intervention;
cost-effectiveness; cost-utility
DOI:
10.1177/2047487320942644
