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Sodium Nitrite-Mediated Cardioprotection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Cost-Effectiveness Analysis.
- Source :
-
Journal of cardiovascular pharmacology and therapeutics [J Cardiovasc Pharmacol Ther] 2019 Mar; Vol. 24 (2), pp. 113-119. Date of Electronic Publication: 2018 Aug 06. - Publication Year :
- 2019
-
Abstract
- Objectives: In the follow-up of patients in a trial of intracoronary sodium nitrite given during primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI), we found a reduction in the incidence of major adverse cardiac events (MACEs). Specifically, MACE rates were 5.2% versus 25.0% with placebo at 3 years ( P = .013). Such MACE reductions should also be associated with economic benefit. Thus, we assessed the cost utility of sodium nitrite therapy versus standard primary PCI only.<br />Methods and Results: We developed a model to simulate costs and quality-adjusted life years (QALYs) over the first 36 months after ST-Segment Elevation Myocardial Infarction (STEMI). Decision tree analysis was used to assess different potential cardiovascular outcomes after STEMI for patients in both treatment groups. Model inputs were derived from the NITRITE-AMI study. Cost of comparative treatments and follow-up in relation to cardiovascular events was calculated from the United Kingdom National Health Service perspective. Higher procedural costs for nitrite treatment were offset by lower costs for repeat revascularization, myocardial infarction, and hospitalization for heart failure compared to primary PCI plus placebo. Nitrite treatment was associated with higher utility values (0.91 ± 0.19 vs 0.82 ± 0.30, P = .041). The calculated incremental cost-effectiveness ratio of £2177 per QALY indicates a cost-effective strategy. Furthermore, positive results were maintained when input parameters varied, indicating the robustness of our model. In fact, based on the difference in utility values, the cost of nitrite could increase by 4-fold (£2006 per vial) and remain cost-effective.<br />Conclusion: This first analysis of sodium nitrite as a cardioprotective treatment demonstrates cost-effectiveness. Although more comparative analysis and assessment of longer follow-up times are required, our data indicate the considerable potential of nitrite-mediated cardioprotection.
- Subjects :
- Clinical Decision-Making
Cost Savings
Cost-Benefit Analysis
Heart Failure economics
Heart Failure etiology
Heart Failure therapy
Hospital Costs
Humans
Models, Economic
Myocardial Infarction etiology
Myocardial Reperfusion Injury etiology
Percutaneous Coronary Intervention adverse effects
Progression-Free Survival
Quality-Adjusted Life Years
Retreatment economics
Sodium Nitrite adverse effects
State Medicine economics
Time Factors
United Kingdom
Vasodilator Agents adverse effects
Drug Costs
Myocardial Infarction economics
Myocardial Infarction prevention & control
Myocardial Reperfusion Injury economics
Myocardial Reperfusion Injury prevention & control
Percutaneous Coronary Intervention economics
ST Elevation Myocardial Infarction economics
ST Elevation Myocardial Infarction therapy
Sodium Nitrite administration & dosage
Sodium Nitrite economics
Vasodilator Agents administration & dosage
Vasodilator Agents economics
Subjects
Details
- Language :
- English
- ISSN :
- 1940-4034
- Volume :
- 24
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular pharmacology and therapeutics
- Publication Type :
- Academic Journal
- Accession number :
- 30081658
- Full Text :
- https://doi.org/10.1177/1074248418784940