A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

McCreanor, Victoria; Graves, Nicholas; Barnett, Adrian; Parsonage, William; Merlo, Gregory

doi:10.12688/f1000research.13616.1

Cited by 5 publications

(5 citation statements)

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“…Adoption of the recommended close to $110 M per year. Our findings add weight to a recent systematic review [2] that reported evidence from five cost effectiveness studies about treatments for stable coronary artery disease. Making changes to policy requires an understanding of the objectives of multiple relevant stakeholders.…”

Section: Discussionsupporting

confidence: 72%

“…There is debate over the clinical value and cost-effectiveness of invasive treatments for patients with triple vessel coronary artery disease [1,2]. While coronary artery bypass grafting (CABG) is recommended for triple vessel disease, especially in the presence of diabetes mellitus and severe left ventricular systolic dysfunction [3], many patients choose multi-vessel percutaneous coronary intervention (PCI) over CABG as their starting treatment option [4,5].…”

Section: Introductionmentioning

confidence: 99%

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The clinical value and cost-effectiveness of treatments for patients with coronary artery disease

et al. 2022

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Background The clinical value and cost-effectiveness of invasive treatments for patients with coronary artery disease is unclear. Invasive treatments such as coronary artery bypass grafting and percutaneous coronary intervention are frequently used as a starting treatment, yet they are much more costly than optimal medical therapy. While patients may transition into other treatments over time, the choices of starting treatments are likely important determinants of costs and health outcomes. The aim is to predict by how much costs and health outcomes will change from a decision to use different starting treatments for patients with coronary artery disease in an Asian setting. Methods A cost-effectiveness study using a Markov model informed by data from Singapore General Hospital was done. All patients with initial presentations of stable coronary disease and no acute coronary syndromes who received medical treatments and interventional therapies were included. We compare existing practice, where the starting treatment can be medical therapy or stent percutaneous coronary interventions or coronary artery bypass grafting, with alternate starting treatment strategies. Results When compared to ‘existing practice’ a policy of starting 14% of patients with coronary artery bypass grafting and 86% with optimal medical therapy showed savings of $1,743 per patient and 0.23 additional quality adjusted life years. A change to policy nationwide would save $10 million and generate 1,380 quality adjusted life years. Conclusions Increasing coronary artery bypass grafting and use of medical therapy in the setting of coronary artery disease is likely to saves costs and improve health outcomes. A definitive study to address the question we investigate would be very difficult to undertake and so using existing data to model the expected outcomes is a useful tool. There are likely to be large and complex barriers to the implementation of any policy change based on the findings of this study.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

The clinical value and cost-effectiveness of treatments for patients with coronary artery disease

et al. 2022

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“…This library also contains subfolders used to categorise papers during the review process. 10.5256/f1000research.13616.d190562 39 …”

Section: Data Availabilitymentioning

confidence: 99%

A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

et al. 2018

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Background: Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for stable coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.

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“…In 2015, about 110 million people were diagnosed with IHD, and 8.9 million patients were died from the disease, accounting for 15.9% of all deaths, and it has become the most common cause of death worldwide [5]. The current treatments for IHD include medications, anti-platelet therapy and surgery [7]. However, the side effects of these methods are unavoidable.…”

Section: Introductionmentioning

confidence: 99%

Oridonin relieves hypoxia-evoked apoptosis and autophagy via modulating microRNA-214 in H9c2 cells

Gong

Zhang

et al. 2019

Artificial Cells, Nanomedicine, and Biotechnology

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Oridonin (Orid) has been diffusely applied to remedy dissimilar cancers. Howbeit, the influence of Orid in ischemic heart disease (IHD) remains imprecise. The current study uncovered the functions of Orid in hypoxia-caused apoptosis and autophagy in H9c2 cells. H9c2 cells received hypoxia and Orid manipulation, cell viability, apoptosis, apoptosis-interrelated factors and autophagy-correlative factors were appraised. After the extraordinary vectors transfections, the impacts of miR-214 inhibition on hypoxia-triggered apoptosis and autophagy were investigated. Further, dual luciferase reporter assay was enforced for ascertaining the pertinence between miR-214 and PTEN. PI3K/AKT/mTOR pathway was finally determined using western blot. We found that, Orid significantly alleviated hypoxia-induced apoptosis and autophagy through regulation their associated proteins in H9c2 cells. Up-regulation of miR-214 was found in hypoxia and Orid co-managed cells, meanwhile, repression of miR-214 obviously annulled the modulatory functions of Orid in hypoxia-evoked apoptosis and autophagy. Additionally, PTEN was forecasted to be a firsthand target of miR-214. Besides, we observed that Orid evoked PI3K/ AKT/mTOR activation through elevation of miR-214 in hypoxia-managed H9c2 cells. In conclusion, the amusing results corroborated that Orid relieved hypoxia-caused apoptosis and autophagy via adjusting PI3K/AKT/mTOR pathway through enhancement of miR-214 in H9c2 cells.

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A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

Cited by 5 publications

References 31 publications

The clinical value and cost-effectiveness of treatments for patients with coronary artery disease

The clinical value and cost-effectiveness of treatments for patients with coronary artery disease

A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

Oridonin relieves hypoxia-evoked apoptosis and autophagy via modulating microRNA-214 in H9c2 cells

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