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Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction.

Publication ,  Journal Article
Mahoney, EM; Jurkovitz, CT; Chu, H; Becker, ER; Culler, S; Kosinski, AS; Robertson, DH; Alexander, C; Nag, S; Cook, JR; Demopoulos, LA ...
Published in: JAMA
October 16, 2002

CONTEXT: In the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS)-Thrombolysis in Myocardial Infarction (TIMI) 18 trial, patients with either unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) treated with the platelet glycoprotein (Gp IIb/IIIa) inhibitor tirofiban had a significantly reduced rate of major cardiac events at 6 months with an early invasive vs a conservative strategy. OBJECTIVE: To examine total 6-month costs and long-term cost-effectiveness of an invasive vs a conservative strategy. DESIGN: Randomized controlled trial including a priori economic end points. SETTING: Hospitalization for UA/NSTEMI with 6-month follow-up period. PATIENTS: A total of 2220 patients with UA/NSTEMI; economic data from 1722 patients at US-non-VA hospitals. INTERVENTION: Early invasive strategy with routine catheterization and revascularization as appropriate vs a conservative strategy with catheterization performed only for recurrent ischemia or a positive stress test. MAIN OUTCOME MEASURE: Total 6-month costs and incremental cost-effectiveness ratio. RESULTS: The average initial hospitalization costs among those in the invasive strategy group were $15714 vs $14047 among those in the conservative strategy group, a difference of $1667 (95% confidence interval [CI], $387-3091). The in-hospital costs were offset significantly at the 6-month follow-up, with an average cost in the invasive group of $6098 vs $7180 in the conservative group, a difference of $1082 (95% CI, -$2051 to $76). The average total costs at 6 months, including productivity costs, for the invasive group was $21 813 vs $21 227 for the conservative group, a $586 difference (95% CI, -$1087 to $2486). The average 6-month costs excluding productivity costs in the invasive group was $19 780 vs $19 111 in the conservative group, a difference of $670, 95% CI; (-$1035 to $2321). Estimated cost per year of life gained for the invasive strategy, based on projected life expectancy, was $12739 for the base case, and ranged from $8371 to $25769, based on model assumptions. CONCLUSIONS: In patients with UA/NSTEMI treated with the Gp IIb/IIIa inhibitor tirofiban, the clinical benefit of an early invasive strategy was achieved with a small increase in cost, yielding favorable projected estimates of cost per year of life gained. These results support the broader use of an early invasive strategy in these patients.

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Published In

JAMA

DOI

ISSN

0098-7484

Publication Date

October 16, 2002

Volume

288

Issue

15

Start / End Page

1851 / 1858

Location

United States

Related Subject Headings

  • United States
  • Tyrosine
  • Tirofiban
  • Quality-Adjusted Life Years
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Outcome and Process Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
 

Citation

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Mahoney, E. M., Jurkovitz, C. T., Chu, H., Becker, E. R., Culler, S., Kosinski, A. S., … TACTICS-TIMI 18 Investigators. Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction, . (2002). Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction. JAMA, 288(15), 1851–1858. https://doi.org/10.1001/jama.288.15.1851
Mahoney, Elizabeth M., Claudine T. Jurkovitz, Haitao Chu, Edmund R. Becker, Steven Culler, Andrzej S. Kosinski, Debbie H. Robertson, et al. “Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction.JAMA 288, no. 15 (October 16, 2002): 1851–58. https://doi.org/10.1001/jama.288.15.1851.
Mahoney EM, Jurkovitz CT, Chu H, Becker ER, Culler S, Kosinski AS, et al. Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction. JAMA. 2002 Oct 16;288(15):1851–8.
Mahoney, Elizabeth M., et al. “Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction.JAMA, vol. 288, no. 15, Oct. 2002, pp. 1851–58. Pubmed, doi:10.1001/jama.288.15.1851.
Mahoney EM, Jurkovitz CT, Chu H, Becker ER, Culler S, Kosinski AS, Robertson DH, Alexander C, Nag S, Cook JR, Demopoulos LA, DiBattiste PM, Cannon CP, Weintraub WS, TACTICS-TIMI 18 Investigators. Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction. Cost and cost-effectiveness of an early invasive vs conservative strategy for the treatment of unstable angina and non-ST-segment elevation myocardial infarction. JAMA. 2002 Oct 16;288(15):1851–1858.
Journal cover image

Published In

JAMA

DOI

ISSN

0098-7484

Publication Date

October 16, 2002

Volume

288

Issue

15

Start / End Page

1851 / 1858

Location

United States

Related Subject Headings

  • United States
  • Tyrosine
  • Tirofiban
  • Quality-Adjusted Life Years
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Outcome and Process Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged