Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation

Abstract 

Aims

The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed.

Methods and results

A total of 1200 patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T were randomized. An early invasive strategy was not superior to a selectively strategy.

Total costs per patient were €1379 (95% CI 416–2356) more expensive in the early invasive group (€13,364) than in the selectively invasive group (€11,985). Costs of revascularization were the main determinant of the cost difference between the two groups. The incremental cost-effectiveness ratio of the extra costs per prevented cardiac event was minus €89,477.

Conclusions

The overall results of the ICTUS study showed that an early invasive strategy was not superior to a selectively invasive strategy for patients with non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. This economic analysis of the ICTUS study showed that an early invasive strategy was slightly more expensive during the first year without gain in prevented cardiac events. In fact, we demonstrated a very moderate probability of the early invasive strategy being cost-efficient, even at a high level of willingness-to-pay.

Abbreviations: CABG, Coronary artery bypass grafting, CAG, Coronary angiography, ICU, Intensive Care Unit, MI, Myocardial infarction, nSTE-ACS, Non-ST-segment elevation acute coronary syndrome, PCI, Percutaneous coronary intervention.

Keywords: Unstable angina, Revascularization, Cost-effectiveness