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Monday, October 20, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Purpose: To develop and apply a framework for determining the cost-effectiveness of using novel circulating biomarkers for prioritising patients with stable angina awaiting coronary bypass surgery (CABG).
Methods: Circulating biomarkers have been recommended as potentially useful measures in the management of patients with coronary artery disease but their cost-effectiveness has not been assessed in relation to any management decision. The aim of the present work was to provide a framework for evaluating biomarkers in such management decisions. An analytic framework consisting of several steps was developed in order to estimate the cost-effectiveness of different prioritisation strategies. A notional cohort of patients assumed to undergo CABG within 90 days was defined. With different prioritisation strategies patients in this notional cohort were assigned a day in which CABG was to be performed. A decision-analytic model was then applied in order to determine costs and health outcomes for patients undergoing CABG on this assigned day. Costs and health outcomes of each prioritisation strategy was estimated by averaging costs and health outcomes for each patient in the notional cohort. Hence, with different prioritisation strategies, a different ‘ordering of the queue’ to CABG is provided, which may spill over to differences in net benefit. In the applied analysis, several strategies for prioritising patients on the waiting list for CABG were compared: clinical risk with biomarkers (C reactive protein and/or Creatinine); clinical risk without biomarkers; urgency scores, and routine clinical practice. Contemporary cardiovascular event rates while waiting for CABG, related to the procedure, and post CABG were obtained from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Meta-analyses of the impact of biomarkers on the risk of cardiovascular events were performed.
Results: The cost-effectiveness results indicated that prioritisation strategies using clinical risk with biomarker information was more costly and more effective compared with other prioritisation strategies. Depending on the price of the biomarker and the size of the effect estimate it provides employing biomarker information could be associated with a health gain at a cost normally considered acceptable.
Conclusions: Although associated with a high degree of uncertainty, the results of the applied analysis showed that for patients with stable coronary artery disease, prioritisation strategies including information from biomarkers may be considered cost-effective.
Methods: Circulating biomarkers have been recommended as potentially useful measures in the management of patients with coronary artery disease but their cost-effectiveness has not been assessed in relation to any management decision. The aim of the present work was to provide a framework for evaluating biomarkers in such management decisions. An analytic framework consisting of several steps was developed in order to estimate the cost-effectiveness of different prioritisation strategies. A notional cohort of patients assumed to undergo CABG within 90 days was defined. With different prioritisation strategies patients in this notional cohort were assigned a day in which CABG was to be performed. A decision-analytic model was then applied in order to determine costs and health outcomes for patients undergoing CABG on this assigned day. Costs and health outcomes of each prioritisation strategy was estimated by averaging costs and health outcomes for each patient in the notional cohort. Hence, with different prioritisation strategies, a different ‘ordering of the queue’ to CABG is provided, which may spill over to differences in net benefit. In the applied analysis, several strategies for prioritising patients on the waiting list for CABG were compared: clinical risk with biomarkers (C reactive protein and/or Creatinine); clinical risk without biomarkers; urgency scores, and routine clinical practice. Contemporary cardiovascular event rates while waiting for CABG, related to the procedure, and post CABG were obtained from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Meta-analyses of the impact of biomarkers on the risk of cardiovascular events were performed.
Results: The cost-effectiveness results indicated that prioritisation strategies using clinical risk with biomarker information was more costly and more effective compared with other prioritisation strategies. Depending on the price of the biomarker and the size of the effect estimate it provides employing biomarker information could be associated with a health gain at a cost normally considered acceptable.
Conclusions: Although associated with a high degree of uncertainty, the results of the applied analysis showed that for patients with stable coronary artery disease, prioritisation strategies including information from biomarkers may be considered cost-effective.
See more of: Poster Session II
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)