Ranolazine for the treatment of chronic stable angina: a cost-effectiveness analysis from the UK perspective

Abstract

ObjectivesTo 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.SettingAn economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon.ParticipantsPatients 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).InterventionRanolazine 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 measuresCosts (£2014) and quality-adjusted life-years (QALYs) for patients receiving and not receiving ranolazine.ResultsRanolazine 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.ConclusionsAlthough 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.

Disfunção Temporomandibular E Dor Orofacial

“…A literatura aponta para uma diversidade de tratamentos para a sintomatologia da DTM, são eles: alongamentos e fortalecimento muscular, correção postural, estimulação elétrica nervosa transcutânea (TENS), fisioterapia, terapia de liberação posicional (TLP), crioterapia, laserterapia, técnicas de terapia manual, cinesioterapia, técnicas de relaxamento, facilitação neuromuscular proprioceptiva (FNP) (SOBRAL et al, 2018AKSU et al, 2019.…”

Ranolazine: A true pluripotent cardiovascular drug or jack of all trades, master of none?

“…29,30,32,34 Cost-Effectiveness Several studies have analysed the cost-effectiveness of ranolazine. [70][71][72] In a systematic review of the existing evidence, Vellopoulou et al found that ranolazine, when added to a standard of care, appeared to be cost-effective primarily due to its ability to decrease angina-related hospitalisation and marginally improve quality of life. 73…”

A Systematic Review on the Economic Evaluations Evidence of Enhanced External Counter-Pulsation (EECP) for Managing Chronic Stable Angina

“…Evidence from the United States showed that the mean total cost for managing stable angina was ∼$28,590 per patient ( 3 ). Estimations in the United Kingdom showed that stable angina imposes more than £700,000,000 on the National Health Service (NHS) per year ( 4 ). In Canada, the total cost for treating CSA was $19,209 per patient per year by the end of 2008 ( 5 ).…”