Analyzing the Efficacy and Cost-effectiveness of Anti-platelet Therapy in Unstable Angina/Non-ST Elevation Myocardial Infarction: A Decision Analysis
| Autor: | Mevin Mathew, Saleh M. M. Rahman, Nimai Patel, Srikar Reddy |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
unstable angina
medicine.medical_specialty Cost effectiveness medicine.medical_treatment 030204 cardiovascular system & hematology nstemi law.invention monte carlo simulations 03 medical and health sciences cardiovascular events 0302 clinical medicine Randomized controlled trial law Internal medicine Internal Medicine Medicine Myocardial infarction non-st elevation myocardial infarction decision analysis Aspirin business.industry Unstable angina monte carlo General Engineering Percutaneous coronary intervention medicine.disease Regimen cardiology Conventional PCI dual platelet therapy Cardiology business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Current pretreatment guidelines for coronary angiography in unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) involve the use of dual antiplatelet therapy (DAPT: aspirin + adenosine diphosphate (ADP) P2Y12 inhibitor), whereas the use of triple antiplatelet therapy (TAPT: aspirin + ADP P2Y12 inhibitor + GpIIb/IIIa inhibitor) has limited data due to the increased bleeding risk. However, a study directly comparing the efficacy and cost-effectiveness of DAPT vs. TAPT has not been done. A decision analysis was constructed to determine the ideal pretreatment antiplatelet regimen for UA/NSTEMI patients. The parameters were calculated based on published randomized clinical trials. They consisted of probabilities based on a pretreatment strategy (DAPT, TAPT), interventions (percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), medical management), and 30-day outcomes (no event, bleeding, vascular event, death). A 10,000 run Monte Carlo simulation provided two outputs: estimated life-years extended and costs for each treatment modality. Quality-adjusted life-years (QALYs) were taken into consideration using calculated coefficients from the literature. The cost/QALY ratio was $1,923/QALY for DAPT vs. $4,734/QALY for TAPT. The use of DAPT for pretreatment was favored (2.46 more cost-effective than TAPT). These results will aid clinicians in providing the most clinically sound and fiscally responsible care for UA/NSTEMI patients. |
| Databáze: | OpenAIRE |
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