Key result
Adding long-acting nitroglycerin to guideline medical therapy proves cost-effective, saving $172 per patient.
Why the study?
The study evaluated the cost-effectiveness of various medical therapy combinations for managing chronic coronary syndrome in Iran using real-world and patient-level data.
Does the combination of β-blockers, long-acting nitroglycerin, aspirin, and statin improve cost-effectiveness in patients with chronic coronary syndrome compared to β-blockers, aspirin, and statin?
Does the combination of β-blockers, long-acting nitroglycerin, aspirin, and statin improve cost-effectiveness in patients with chronic coronary syndrome compared to β-blockers, aspirin, and statin?
Adding long-acting nitroglycerin to standard medical therapy for chronic coronary syndrome is highly cost-effective and potentially cost-saving in Iran.
May support adding long-acting nitroglycerin as cost-saving in Iranian chronic coronary syndrome; leaves open generalizability pending randomized confirmation.
OBJECTIVES: The main objective was to evaluate the cost-effectiveness of various medical therapy combinations in managing chronic coronary syndrome (CCS) in Iran, based on real-world and patient-level data. DESIGN: A cost-utility analysis employing a Markov model was conducted using data from a retrospective cohort study. SETTING: The study was conducted in the healthcare setting of Iran, focusing on primary and secondary care. PARTICIPANTS: Patients with CCS were included in the study. Numbers entering and completing the study were reported, with clear definitions of selection, entry and exclusion criteria. INTERVENTIONS: All combinations of recommended medical therapies for CCS were permitted. Ultimately, taking into account the sample size and study power, a comparison was made between the combination therapy of β-blockers (BB), long-acting nitroglycerin (LAN), aspirin (ASA) and statin versus the group receiving only BB, ASA and statin. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the incremental cost-effectiveness ratio, along with an initial evaluation of disability-adjusted life-years (DALYs) and costs related to the interventions. RESULTS: The BB/LAN/ASA/statin combination was cost-saving and effective, averting 0.02 DALYs and saving $172 compared with BB/ASA/statin. This combination was cost-effective in over 97% of the probabilistic sensitivity analysis results. CONCLUSIONS: Incorporating LAN into the combination therapy of BB, ASA and statin is cost-effective in Iran. This finding provides evidence for policymakers on resource allocation in low-income countries.
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Davari et al. (2025) studied Chronic coronary syndrome (CCS) (n=505). Combination therapy of β-blockers, long-acting nitroglycerin, aspirin, and statin vs. Combination therapy of β-blockers, aspirin, and statin was evaluated on Incremental cost-effectiveness ratio (ICER) (Dominant (cost-saving and effective)). The combination of β-blockers, long-acting nitroglycerin, aspirin, and statin was cost-saving and effective, averting 0.02 DALYs and saving $172 compared with β-blockers, aspirin, and statin.
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