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Potential Costs and Effects of the National Service Framework for Coronary Heart Disease in the UK

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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 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 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 (1997 values).

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

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Acknowledgements

The author is grateful to Peter West, Director of the York Health Economic Consortium for his suggestions.

No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. Department of Health, Italian Cooperation, Natalia Building, 10th floor, North Tower, Room 6C, 330 Longmarket Street, Private Bag X9051, Pietermaritzburg, 3200, Republic of South Africa

    Venanzio Vella

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  1. Venanzio Vella
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Correspondence to Venanzio Vella.

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Vella, V. Potential Costs and Effects of the National Service Framework for Coronary Heart Disease in the UK. Pharmacoeconomics 21, 49–60 (2003). https://doi.org/10.2165/00019053-200321010-00004

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