Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
Fitzpatrick, Natalie K
Hingorani, Aroon D
Shipley, Martin J
MetadataShow full item record
AbstractTo determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of pound20,000- pound30,000 (euro22,000-euro33,000; $32,000-$48,000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was < pound410 compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100,000 patients at an additional cost of pound 245,000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate.
The following licence applies to the copyright and re-use of this item:
- Creative Commons
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/
- The effectiveness and cost-effectiveness of biomarkers for the prioritisation of patients awaiting coronary revascularisation: a systematic review and decision model.
- Authors: Hemingway H, Henriksson M, Chen R, Damant J, Fitzpatrick N, Abrams K, Hingorani A, Janzon M, Shipley M, Feder G, Keogh B, Stenestrand U, McAllister K, Kaski JC, Timmis A, Palmer S, Sculpher M
- Issue date: 2010 Feb
- Systematic review, meta-analysis and economic modelling of diagnostic strategies for suspected acute coronary syndrome.
- Authors: Goodacre S, Thokala P, Carroll C, Stevens JW, Leaviss J, Al Khalaf M, Collinson P, Morris F, Evans P, Wang J
- Issue date: 2013
- Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective.
- Authors: Osnabrugge RL, Magnuson EA, Serruys PW, Campos CM, Wang K, van Klaveren D, Farooq V, Abdallah MS, Li H, Vilain KA, Steyerberg EW, Morice MC, Dawkins KD, Mohr FW, Kappetein AP, Cohen DJ, SYNTAX trial investigators.
- Issue date: 2015 Dec
- Using biomarkers to prioritise patients with stable angina pectoris for bypass surgery.
- Authors: Terkelsen CJ, Vach W
- Issue date: 2010 Jan 20
- Influence of intraoperative conversion from off-pump to on-pump coronary artery bypass grafting on costs and quality of life: a cost-effectiveness analysis.
- Authors: Shiga T, Apfel CC, Wajima Z, Ohe Y
- Issue date: 2007 Dec