Costs of an early intervention versus a conservative strategy in acute coronary syndrome

Abstract

Background The Randomised Intervention Treatment of unstable Angina (RITA-3) found that non-ST-elevation myocardial infarction and unstable angina patients randomised to routine early arteriography experienced a lower rate of death or myocardial infarction than patients randomised to conservative therapy over a five year period of follow up. This paper uses data from the RITA-3 trial to compare the health service costs of the two strategies. Methods The resource use data included initial arteriography and revascularisation procedures in the early intervention group and subsequently in both groups; in-patient days in hospital for any reason in the first year of follow-up; incidence of myocardial infarction; and cardiac medication. Results After five years, the early intervention arm accrued a total mean cost of £11,340 (€15,592) and the conservative arm a mean of £9749(€13,405), an additional mean cost in the intervention arm of £1591 (95% CI £851 to £2276) (€2188; 95%CI €1160 to €3228). On average, costs increased with age and were higher in male patients and in patients with severe angina. However, the incremental cost of the intervention strategy was consistent across different patient sub-groups. Conclusion Over a period of 5 years, the initial additional cost of a strategy of early intervention is only partially offset by subsequent interventions in patients managed conservatively.