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: | McEntegart, Dr Margaret and Heggie, Mr Robert and Stanley, Miss Bethany and Ford, Thomas and Collison, Dr Damien and Oldroyd, Dr Keith and Berry, Professor Colin and YII, Dr Eric |
| 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 > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment College of Medical Veterinary and Life Sciences > School of Health & 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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