Abstract
AimCoronary angiography is indicated in many patients with known or suspected angina for the investigation of coronary artery disease (CAD). However, up to half of patients with symptoms of ischaemia have no obstructive coronary arteries (INOCA). This large subgroup includes patients with suspected microvascular angina (MVA) and/or vasospastic angina (VSA). Clinical guidelines relating to the management of patients with INOCA are limited. Uncertainty regarding the diagnosis of patients with INOCA presents a health economic challenge, both in terms of healthcare resource utilisation and of quality-of-life impact on patients. MethodsA cost-effectiveness analysis of the introduction of stratified medicine into the invasive management of INOCA, based on clinical and resource-use data obtained in the CorMicA trial, from a UK NHS perspective. The intervention included an invasive diagnostic procedure (IDP) of coronary vascular function during coronary angiography to define clinical endotypes to target with linked medical therapy. Outcomes of interest were mean total cost and QALY gain between treatment groups, and the incremental cost-effectiveness ratio. We undertook probabilistic sensitivity and scenario analyses. ResultsThe incremental cost per QALY gained at 12 months was £4500 (£2937, £33264). Compared with a willingness-to-pay (WTP) threshold of £20,000 per QALY, the use of the IDP test is cost-effective. At this WTP threshold there is a 96% probability of the IDP being cost-effective, based on the uncertainty described by bootstrap analysis. ConclusionsThe burden of INOCA, particularly in women, is known to be significant. These findings provided new evidence to inform this unmet clinical need.
Highlights
Coronary angiography is routinely performed in patients with suspected angina
The aim of this study was to undertake a cost-effectiveness analysis of the British Heart Foundation (BHF) CorMicA trial, using resource use and quality of life data from the trial, to estimate the potential cost-effectiveness of the use of the invasive diagnostic procedure (IDP) among ischaemia have no obstructive coronary arteries (INOCA) patients undergoing routine coronary angiography
Given the large potential cost associated with these rerepresentations, we modelled the impact of IDP testing on reducing the proportion of patients re-presenting to primary and secondary care with signs/symptoms of angina following coronary angiography
Summary
Coronary angiography is routinely performed in patients with suspected angina. Approximately four million elective coronary angiograms are performed each year in Europe and the United States⁎ Correspondence to: R. Coronary angiography is routinely performed in patients with suspected angina. Four million elective coronary angiograms are performed each year in Europe and the United States. Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, 1 Lilybank Gardens, Glasgow G12 8RZ, United Kingdom. British Heart Foundation Glasgow Cardiovascuar Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. Hitherto undifferentiated subpopulation [3]. This is important because discrimination between microvascular angina, vasospastic angina, both, or neither, allows for specific and distinct treatment regimes. Adjustive coronary function testing provides both patients and their physicians with prognostic information. Clinical guidelines relating to the management of patients with INOCA are limited by a lack of randomised controlled trials [5]
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