A UK trial-based cost–utility analysis of transmyocardial laser revascularization compared to continued medical therapy for treatment of refractory angina pectoris

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• 作者：Campbell ; H.E. ; Tait ; S. ; Buxton ; M.J. ; Sharples ; L.D. ; Caine ; N. ; Schofield ; P.M. ; Wallwork ; J.
• 关键词：Transmyocardial laser revascularization ; Randomized-controlled trial ; Cost ; Quality adjusted life year ; Cost&ndash ; utility analysis
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2001
• 出版时间：August, 2001
• 年：2001
• 卷：20
• 期：2
• 页码：312-318
• 全文大小：126 K

文摘

Objective: Transmyocardial laser revascularization (TMLR) is used to treat patients with refractory angina considered unsuitable for conventional forms of revascularization. Using patient specific data from a single centre UK randomised-controlled trial, we aimed to determine whether, from a UK National Health Service (NHS) perspective, TMLR plus standard medical management is cost-effective when compared with standard medical management alone. Methods: One hundred and eighty-eight patients assessed as having refractory angina, and not suitable for conventional forms of revascularization were randomized to receive TMLR and medical management (94) or medical management alone (94). Costs to the UK NHS of TMLR (where appropriate), and all secondary sector health care contacts and cardiac-related medication in the 12 months following randomization, were collected. Patient utility as measured using the EuroQol EQ-5D questionnaire was combined with 12-month survival data to generate quality adjusted life years (QALYs). Results: The mean cost per patient over the year from hospitalization for TMLR was £11,470 and for medical management alone was £2586, giving a cost difference of £8901 (95 % confidence interval (CI) £7502–£10,008: P<0.0001). The mean QALY difference, in favour of TMLR was 0.039 (95 % CI −0.033 to 0.113: P=0.268). This gives an incremental cost per QALY of over £228,000. Analysis of stochastic uncertainty and of sensitivity to gross changes in key parameters consistently produces very high costs per QALY. Conclusions: The policy implications are clear: for such patients TMLR is an inefficient use of UK health service resources. This conclusion would not be changed by considerable improvements in effectiveness or reductions in cost.