Abstract
Background: COURAGE compared percutaneous coronary intervention (PCI) plus intensive pharmacologic and lifestyle intervention (optimal medical therapy, OMT) to OMT alone in reducing the risk of cardiovascular events in patients with stable coronary disease. In this post hoc study, we assessed the cost of treating angina across the three health care systems from which patients were enrolled: Canada, US non-Veterans Affairs (VA) and U.S. VA. Methods: A total of 2,287 patients were enrolled and followed for a median of 4.6 years. Angina-related health status was assessed with the Seattle Angina Questionnaire (SAQ) and RAND-36. The cost of resource use was evaluated by DRG for hospitalizations and CPT for outpatient visits and tests. Analyses were conducted using the U.S. non-VA costing system in 2004 U.S. dollars. Clinically significant differences in the Physical Limitation, Angina Frequency, and Quality of Life domains of the SAQ were defined as scores ≥8, ≥20, and ≥16 respectively. Absolute net benefit, number of patients needed to treat (NNT) to achieve one patient with clinically significant angina improvement, and the cost of improvement in angina-related health status were estimated. Results: Added cost of PCI per patient and results for Angina Frequency are presented in the table . Results for Quality of Life were similar. Physical Limitation results varied more widely among health care systems with net benefit ranging from <1% (U.S. non-VA) to 18% (Canada), and cost per patient in angina improvement from $55,700 (Canada) to over $1,000,000 (U.S. non-VA). Conclusions: The improvement of angina-related health status and corresponding costs were relatively similar across health care systems and among SAQ Angina Frequency and Quality of Life domains, but varied widely for the Physical Limitation Domain. Adding PCI to OMT improved angina-related health status, but at a cost generally considered to be prohibitive as a routine initial management strategy. Cost of Improvement of Angina-Related Health Status by Health Care System
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