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Trial-based cost-utility comparison of percutaneous myocardial laser revascularisation and continued medical therapy for treatment of refractory angina pectoris

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Abstract

This study examined from a health service perspective whether percutaneous myocardial laser revascularisation (PMR) plus standard medical management is cost-effective when compared with standard medical management alone in the treatment of refractory angina. This involved a cost-utility analysis using patient-specific data from a single-centre, randomised, controlled trial carried out in the United Kingdom. Of 73 patients diagnosed as having refractory angina and not suitable for conventional forms of revascularisation, 36 were randomised to PMR plus medical management and 37 to medical management alone. We collected costs to the health service of PMR and all secondary sector health care contacts and cardiac-related medication in the 12 months following randomisation. Patient utility, measured using the EuroQol EQ-5D questionnaire, was combined with 12-month survival data to generate quality-adjusted life years (QALYs). The mean 12-month cost per patient for PMR was £8,307, and that for medical management was £1,888, giving a cost difference of £6,410. The mean QALY difference favoured PMR at 0.126, giving an incremental cost per QALY of £50,873. The cost-effectiveness acceptability curve indicates that the probability of PMR being cost-effective over the first 12 months is quite low. Whilst a longer period of follow-up might indicate continued benefit from PMR, which would make the intervention economically more attractive, PMR could not be considered cost-effective based on 1-year follow-up data.

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Acknowledgements

We are grateful to all of the patients and professionals who were involved with the trial, particularly Dr. Sarah Clark and the staff of the Radiology Department who assisted with the PMR procedures. We also thank Dr. Divna Batas, the trial’s research assistant, Paula Allen, who helped interview patients, and Matthew Dyer, who assisted with the economic analysis. The laser equipment was provided for the trial by CardioGenesis. Helen Campbell carried out the economic analysis and produced a draft of the paper. Sue Tait was responsible for the collection and recording of data during the trial. Martin Buxton designed the economic evaluation, supervised the analysis and produced the final draft. Linda Sharples was involved in the design of the trial and managed the statistical aspects of the study and analysis. Noreen Caine planned and coordinated the whole study and stands as guarantor. Tim Gray and Peter Schofield led the clinical investigation, and contributed to the design and running of the trial. All authors contributed to the interpretation of the results and the writing of this report. We are grateful for the comments of anonymous referees who helped improve the clarity of the paper. The research was funded by CardioGenesis and Papworth Hospital NHS Trust Research and Development Department, with additional support to the Health Economics Research Group from the Department of Health Policy Research Programme. Treatment costs were funded by the NHS Health authorities.

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  1. Martin J. Buxton

    Present address: Health Economics Research Group, Brunel University, Uxbridge, UB8 3PH, UK

Authors and Affiliations

  1. Health Economics Research Group, Brunel University, Uxbridge, UK

    Helen E. Campbell & Martin J. Buxton

  2. Papworth Hospital NHS Trust, Cambridge, UK

    Sue Tait, Noreen Caine, Timothy J. Gray & Peter M. Schofield

  3. MRC Biostatistics Unit, Cambridge, UK

    Linda D. Sharples

Authors
  1. Helen E. Campbell
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  2. Sue Tait
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  3. Linda D. Sharples
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  6. Peter M. Schofield
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  7. Martin J. Buxton
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Correspondence to Martin J. Buxton.

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Campbell, H.E., Tait, S., Sharples, L.D. et al. Trial-based cost-utility comparison of percutaneous myocardial laser revascularisation and continued medical therapy for treatment of refractory angina pectoris. Eur J Health Econ 6, 288–297 (2005). https://doi.org/10.1007/s10198-005-0310-5

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