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European Heart Journal 1997 18(Supplement B):35-42; doi:10.1093/eurheartj/18.suppl_B.35
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Is medical treatment for angina the most cost-effective option?

J. G. F. Cleland* and A. Walker{dagger}

* Medical Research Council Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow Glasgow, U.K.
{dagger} Health Economics Unit, Greater Glasgow Health Board Glasgow, U.K.

Correspondence: Dr John G. F. Cleland, Medical Research Council Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow, Glasgow, G12 8QQ, U.K.

A meta-analysis of the benefits of coronary artery bypass graft (CABG) surgery has been used as the basis of a model for comparing the costs and benefits of surgical and medical treatment of angina pectoris. In order to allow for the results of recent research, the economic model included the addition of aspirin and aspirin plus an HMG-CoA reductase inhibitor (statin) to medical management. The analysis indicates that in unselected patients the cost-effectiveness of CABG vs initial standard medical therapy over 5 years is towards the upper limit of what can be considered a cost-effective treatment both in terms of its effect on mortality (life-years gained) and morbidity (quality adjusted life-years). Addition of a statin to medical therapy reduced mortality and made coronary artery bypass graft surgery an expensive option in terms of improvement of quality of life. In patients with three-vessel disease or left ventricular dysfunction surgery appears fairly cost-effective in comparison with standard medical therapy but becomes relatively expensive when the benefits of aspirin or lipid-lowering therapy are added to medical treatment.

Key Words: Coronary artery bypass • angioplasty • antiischaemic drugs • cost-benefit analysis


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