Costs of an early intervention versus a conservative strategy in acute coronary syndrome

Epstein, DM; Sculpher, MJ; Clayton, TC; Henderson, RA; Pocock, SJ; Buxton, MJ; Fox, KAA; (2008) Costs of an early intervention versus a conservative strategy in acute coronary syndrome. International journal of cardiology, 127 (2). pp. 240-246. ISSN 0167-5273 DOI:

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Background: The Randomised Intervention Treatment of unstable Angina (RITA-3) found that non-ST-elevation myocardial infarction and unstable angina patients randomised to routine early arteriography experienced a lower rate of death or myocardial infarction than patients randomised to conservative therapy over a five year period of follow up. This paper uses data from the RITA-3 trial to compare the health service costs of the two strategies. Methods: The resource use data included initial arteriography and revascularisation procedures in the early intervention group and subsequently in both groups; in-patient days in hospital for any reason in the first year of follow-up; incidence of myocardial infarction; and cardiac medication. Results: After five years, the early intervention arm accrued a total mean cost of 11,340 pound (is an element of 15,592) and the conservative arm a mean of 9749( pound is an element of 13,405), an additional mean cost in the intervention arm of 1591 pound (95% CI 851 pound to 2276) pound (is an element of 2188; 95% CI is an element of 1160 to is an element of 3228). On average, costs increased with age and were higher in male patients and in patients with severe angina. However, the incremental cost of the intervention strategy was consistent across different patient sub-groups. Conclusion: Over a period of 5 years, the initial additional cost of a strategy of early intervention is only partially offset by subsequent interventions in patients managed conservatively. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 17707103
Web of Science ID: 256661000015


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