Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2019 Sep 20;9(9):e030678. doi: 10.1136/bmjopen-2019-030678.
Non-ST-elevation myocardial infarction (NSTEMI) is the most common type of heart attack in the UK and it is becoming increasingly prevalent among older people. An early invasive treatment strategy may be effective and cost-effective for treating NSTEMI but evidence is currently unclear.
To assess the cost-effectiveness of the early invasive strategy versus medical management in elderly patients with NSTEMI and to provide guidance for future research in this area.
A long-term Markov state transition model was developed. Model inputs were systematically derived from a number of sources most appropriate to a UK relevant analysis, such as published studies and national routine data. Costs were estimated from the perspective of National Health Service and Personal Social Services. The model was developed using TreeAge Pro software. Based on a probabilistic sensitivity analysis, a value of information analysis was carried out to establish the value of decision uncertainty both overall and for specific input parameters.
In 2017 UK £, the incremental cost-effectiveness ratio of the early invasive strategy was £46 916 for each additional quality-adjusted life-year (QALY) gained, with a probability of being cost-effective of 23% at a cost-effectiveness threshold of £20 000/QALY. There was a considerable decision uncertainty with these results. The value of removing all this uncertainty was up to £1 920 000 annually. Most uncertainty related to clinical effectiveness parameters and the optimal study design to remove this uncertainty would be a randomised controlled trial.
Based on current evidence, the early invasive strategy is not likely to be cost-effective for elderly patients with NSTEMI. This conclusion should be interpreted with caution mainly due to the absence of NSTEMI-specific data and long-term clinical effectiveness estimates.
非 ST 段抬高型心肌梗死（NSTEMI）是英国最常见的心脏病发作类型，在老年人中越来越普遍。早期侵入性治疗策略可能对治疗 NSTEMI 有效且具有成本效益，但目前证据尚不清楚。
评估早期侵入性策略与 NSTEMI 老年患者的药物治疗相比的成本效益，并为该领域的未来研究提供指导。
开发了一个长期的马尔可夫状态转移模型。模型输入是从最适合英国相关分析的多个来源系统地推导出来的，例如已发表的研究和国家常规数据。成本是从国民保健服务和个人社会服务的角度估算的。该模型是使用 TreeAge Pro 软件开发的。基于概率敏感性分析，进行了信息价值分析，以确定总体和特定输入参数的决策不确定性的价值。
在 2017 年的英国£中，早期侵入性策略的增量成本效益比为每获得额外的质量调整生命年（QALY）增加£46916，在成本效益阈值为£20000/QALY 的情况下，具有成本效益的概率为 23%。这些结果存在相当大的决策不确定性。消除所有这些不确定性的价值高达每年£192 万。大部分不确定性与临床疗效参数有关，消除这种不确定性的最佳研究设计将是一项随机对照试验。
基于目前的证据，早期侵入性策略不太可能对 NSTEMI 老年患者具有成本效益。由于缺乏 NSTEMI 特异性数据和长期临床疗效估计，应谨慎解释这一结论。
