Stratified medicine using invasive coronary function testing in angina: a cost-effectiveness analysis of the British Heart Foundation CorMicA trial

Heggie, R. et al. (2021) Stratified medicine using invasive coronary function testing in angina: a cost-effectiveness analysis of the British Heart Foundation CorMicA trial. International Journal of Cardiology, 337, pp. 44-51. (doi: 10.1016/j.ijcard.2021.05.016) (PMID:33992700)

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Abstract

Aim: Coronary angiography is indicated in many patients with known or suspected angina for the investigation of coronary artery disease (CAD). However, up to half of patients with symptoms of ischaemia have no obstructive coronary arteries (INOCA). This large subgroup includes patients with suspected microvascular angina (MVA) and/or vasospastic angina (VSA). Clinical guidelines relating to the management of patients with INOCA are limited. Uncertainty regarding the diagnosis of patients with INOCA presents a health economic challenge, both in terms of healthcare resource utilisation and of quality-of-life impact on patients. Methods: A cost-effectiveness analysis of the introduction of stratified medicine into the invasive management of INOCA, based on clinical and resource-use data obtained in the CorMicA trial, from a UK NHS perspective. The intervention included an invasive diagnostic procedure (IDP) of coronary vascular function during coronary angiography to define clinical endotypes to target with linked medical therapy. Outcomes of interest were mean total cost and QALY gain between treatment groups, and the incremental cost-effectiveness ratio. We undertook probabilistic sensitivity and scenario analyses. Results: The incremental cost per QALY gained at 12 months was £4500 (£2937, £33,264). Compared with a willingness-to-pay (WTP) threshold of £20,000 per QALY, the use of the IDP test is cost-effective. At this WTP threshold there is a 96% probability of the IDP being cost-effective, based on the uncertainty described by bootstrap analysis. Conclusions: The burden of INOCA, particularly in women, is known to be significant. These findings provided new evidence to inform this unmet clinical need.

Item Type:Articles
Additional Information:This work was funded by a British Heart Foundation grant (PG/17/2532884, RE/13/5/ 30177, and RE/18/6134217).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Stanley, Miss Bethany and Ford, Thomas and Collison, Dr Damien and McEntegart, Dr Margaret and YII, Dr Eric and Heggie, Mr Robert and Oldroyd, Dr Keith
Authors: Heggie, R., Briggs, A., Stanley, B., Good, R., Rocchiccioli, P., McEntegart, M., Watkins, S., Eteiba, H., Shaukat, A., Lindsay, M., Robertson, K., Hood, S., McGeoch, R., McDade, R., YII, E., Collison, D., Oldroyd, K., Ford, T. J., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:13 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in International Journal of Cardiology 337: 44-51
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301454CORonary MICrovascular Angina (CorMicA): a pilot trial with a nested MRI sub-studyColin BerryBritish Heart Foundation (BHF)PG/17/25/32884CAMS - Cardiovascular Science
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science