RESUMO
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. 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. 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.
Assuntos
Custos de Medicamentos , Infarto do Miocárdio/economia , Infarto do Miocárdio/prevenção & controle , Traumatismo por Reperfusão Miocárdica/economia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Intervenção Coronária Percutânea/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Nitrito de Sódio/administração & dosagem , Nitrito de Sódio/economia , Vasodilatadores/administração & dosagem , Vasodilatadores/economia , Tomada de Decisão Clínica , Redução de Custos , Análise Custo-Benefício , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Custos Hospitalares , Humanos , Modelos Econômicos , Infarto do Miocárdio/etiologia , Traumatismo por Reperfusão Miocárdica/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervalo Livre de Progressão , Anos de Vida Ajustados por Qualidade de Vida , Retratamento/economia , Nitrito de Sódio/efeitos adversos , Medicina Estatal/economia , Fatores de Tempo , Reino Unido , Vasodilatadores/efeitos adversosAssuntos
Angioplastia Coronária com Balão/métodos , Ponte de Artéria Coronária/métodos , Doença das Coronárias/terapia , Angioplastia Coronária com Balão/economia , Prótese Vascular/efeitos adversos , Prótese Vascular/economia , Ponte de Artéria Coronária/economia , Doença das Coronárias/economia , Stents Farmacológicos/efeitos adversos , Stents Farmacológicos/economia , Humanos , Traumatismo por Reperfusão Miocárdica/economia , Traumatismo por Reperfusão Miocárdica/etiologia , Falha de Prótese/economia , Reoperação/economia , Reoperação/métodos , Resultado do TratamentoRESUMO
In the setting of acute coronary syndromes, thrombotic embolization and activation of platelets with release of vasoconstrictors into the downstream microvasculature may occur before cardiac catheterization. In the Treat Angina with tirofiban and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18 (TACTICS-TIMI 18) trial angiographic substudy, a shorter duration of tirofiban infusion before percutaneous coronary intervention was associated with impaired myocardial perfusion before and after intervention.