Key result
Adding nicorandil to usual angina therapy saves ~£5 per averted major event by reducing hospital services.
Why the study?
The net cost and cost-effectiveness of adding nicorandil to usual treatment for patients with angina were not well established.
Does adding nicorandil to usual treatment improve cost-effectiveness and clinical outcomes in patients with angina?
Does adding nicorandil to usual treatment improve cost-effectiveness and clinical outcomes in patients with angina?
Effect estimate: -5 pounds sterling
Adding nicorandil to usual treatment for angina is highly cost-effective, as a substantial amount of the additional drug cost is offset by reduced use of hospital services.
May support nicorandil cost-effectiveness in angina; leaves open prospective validation of net savings.
OBJECTIVE: To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit. DESIGN: Cost effectiveness analysis. SETTING: Based on results of the IONA (impact of nicorandil on angina) trial. PATIENTS: Patients with angina fulfilling the entry criteria for the IONA trial. INTERVENTIONS: In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone. MAIN OUTCOME MEASURES: Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial. RESULTS: The net cost for each additional IONA trial end point averted was -5 pounds sterling (-7 euros). The net cost for each case of acute coronary syndrome averted was -8 pounds sterling (-12 euros). The net cost for each event-free survivor was -5 pounds sterling (-7 euros). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to 567 pounds sterling (835 euros), 886 pounds sterling (1305 euros), and 516 pounds sterling (760 euros), respectively. CONCLUSIONS: A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably.
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Walker et al. (2006) studied angina. nicorandil vs. existing treatment alone was evaluated on Net cost for each additional IONA trial end point averted (CHD death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain) (-5 pounds sterling). Adding nicorandil to usual treatment for angina resulted in a net cost of -5 pounds sterling per primary trial endpoint averted, as reduced hospital services offset the drug cost.
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