International Research and Opinion 6 __________________________________________________ __

Medical treabnent cost effective inIHD

Medical treatment for patients with ischaemic heart disease (IHD) is more cost effective than surgery, suggest investigators from the University of Glasgow and the Greater Glasgow Health Board, UK.

They compared the costs and benefits of medical treatment with those of revascularisation in a hypothetical cohort of 100 patients with IHD. Medical treatment included standard drug therapy (e.g. l3-blocker or calcium antagonist) plus aspirin or aspirin and simvastatin. Costs included those associated with drug acquisition, coronary artery bypass grafting, routine follow-up and nonfatal myocardial infarction.

Swgery vs simvastatin - no swvival advantage Over a lO-year timeframe, the total direct cost

associated with surgery was estimated to be £786 461, compared with £484 465 for standard medical treat­ment plus aspirin and £836 263 for standard medical treatment plus both aspirin and simvastatin. The extra number of life-years gained by surgery over a 10-year timeframe was 28, compared with standard medical treatment plus aspirin, but there was no survival advantage compared with standard medical therapy plus aspirin and simvastatin.

The investigators point out that, overall, the impact of surgery on life-years gained and quality of life was low, compared with the regimen that included simvastatin. However, surgery would be cost effective (£8248/quality-adjusted life-year) in patients with severe angina pectoris.

Give IHD patients a statin The investigators conclude that all patients with

IHD 'should receive a statin in addition to medical therapy and aspirin'. However, surgery would be indicated for the relief of symptoms in patients with severe angina pectoris.

Cleland JGF, Walker A. Therapeutic options and cost considerations in the treatment of ischemic heart disease. Cardiovascular Drugs and Therapy 12 (Suppl. 3): 225-232, oct 1998 Il00722637

PhannacoEconomics& OutcomssNews28 Nov 1998 No. leO 1173-5503I9810190-0006/$Ol.orf' Adl. International Limited 1998. All rights reurvecI