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Pharmacoeconomics. 2003;21(1):49-60.

Potential costs and effects of the National Service Framework for Coronary Heart Disease in the UK.

Author information

1
Department of Health, Italian Cooperation, Pietermaritzburg, Republic of South Africa. Thevellas@yahoo.it

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 pounds 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 pounds 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 pounds (1997 values).

CONCLUSIONS:

Abciximab and probably any glycoprotein IIb/IIIa receptor antagonists should be added to any PCI, especially if stents are used.

[Indexed for MEDLINE]

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