Potential Costs and Effects of the National Service Framework for Coronary Heart Disease in the UK

Objective: To estimate the costs and effect of implementing the National Service Framework for Coronary Heart Disease (CHD) in the UK. Design: Decision trees were built on the results from randomised controlled trials on improving coronary revascularisation. All costs were presented in UK pounds (1997 values). Patients: Each year 6600 new patients with CHD are expected to require revascularisation in the UK. Interventions: The new patients would be equally divided into those undergoing coronary artery bypass grafting (CABG) and those undergoing a percutaneous coronary intervention (PCI) i.e., percutaneous transluminal angioplasty (PCTA). PTCA could be administered with or without abciximab (a glycoprotein IIb/IIIa receptor antagonist), stent, or stent plus abciximab (stent+). Results: CABG/stent alone has an incremental cost of more than Lstg 115 489 per additional quality-adjusted life-year (QALY) gained compared with CABG/ PTCA+. This high incremental cost is not attractive because if CABG/ stent would be added to abciximab (CABG/stent+) its incremental cost-effectiveness ratio would be Lstg 2529 per extra QALY compared with CABG/stent. Therefore, the debate should not be limited to the issue of stents but it should focus on the need for administering abciximab in addition to stent. The 5-year direct costs of implementing such a strategy in the UK is expected to be Lstg 50.6 million (1997 values). Conclusions: Abciximab and probably any glycoprotein IIb/IIIa receptor antagonists should be added to any PCI, especially if stents are used.