Key result
Ranolazine added to standard-of-care was a dominant economic strategy, yielding 0.701 QALYs at £5208 compared to 0.662 QALYs at £5318 for standard-of-care alone over a 1-year horizon.
Why the study?
Does ranolazine added to standard-of-care improve cost-effectiveness (costs and QALYs) in patients with stable coronary disease experiencing ≥3 angina attacks/week?
Does ranolazine added to standard-of-care improve cost-effectiveness (costs and QALYs) in patients with stable coronary disease experiencing ≥3 angina attacks/week?
Ranolazine added to standard-of-care is likely a cost-effective and economically dominant strategy for patients with stable coronary disease and frequent angina in the UK.
Answers are grounded in this paper and cite their sources.
Supports UK prescribing decisions for frequent angina; leaves open need for prospective validation in diverse settings.
OBJECTIVES: To estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ≥3 attacks/week. SETTING: An economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon. PARTICIPANTS: Patients with stable coronary disease experiencing ≥3 attacks/week starting in 1 of 4 angina frequency health states based on Seattle Angina Questionnaire Angina Frequency (SAQAF) scores (100=no; 61-99=monthly; 31-60=weekly; 0-30=daily angina). INTERVENTION: Ranolazine added to SoC or SoC alone. Patients were allowed to transition between SAQAF states (first cycle only) or death (any cycle) based on probabilities derived from the randomised, controlled Efficacy of Ranolazine in Chronic Angina trial and other studies. Patients not responding to ranolazine in month 1 (not improving ≥1 SAQAF health state) discontinued ranolazine and were assumed to behave like SoC patients. PRIMARY AND SECONDARY OUTCOMES MEASURES: Costs (£2014) and quality-adjusted life-years (QALYs) for patients receiving and not receiving ranolazine. RESULTS: Ranolazine patients lived a mean of 0.701 QALYs at a cost of £5208. Those not receiving ranolazine lived 0.662 QALYs at a cost of £5318. The addition of ranolazine to SoC was therefore a dominant economic strategy. The incremental cost-effectiveness ratio was sensitive to ranolazine cost; exceeding £20,000/QALY when ranolazine's cost was >£203/month. Ranolazine remained a dominant strategy when indirect costs were included and mortality rates were assumed to increase with worsening severity of SAQAF health states. Monte Carlo simulation found ranolazine to be a dominant strategy in ∼71% of 10,000 iterations. CONCLUSIONS: Although UK-specific data on ranolazine's efficacy and safety are lacking, our analysis suggest ranolazine added to SoC in patients with weekly or daily angina is likely cost-effective from a UK health system perspective.
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Coleman et al. (2015) studied stable coronary disease. Ranolazine added to standard-of-care vs. Standard-of-care alone was evaluated on Costs (£2014) and quality-adjusted life-years (QALYs). Ranolazine added to standard-of-care was a dominant economic strategy, yielding 0.701 QALYs at £5208 compared to 0.662 QALYs at £5318 for standard-of-care alone over a 1-year horizon.
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