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European Heart Journal 2002 23(16):1291-1300; doi:10.1053/euhj.2001.3075
Copyright © 2002 by the European Society of Cardiology.
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Coronary angioplasty versus medical therapy for angina. Health service costs based on the second Randomized Intervention Treatment of Angina (RITA-2) trial

M.J. Sculphera,f1, D.H. Smitha, T. Claytonb, R.A. Hendersonc, M.J. Buxtond, S.J. Pocockb and D.A. Chamberlaine

a Centre for Health Economics, University of York, York, U.K.
b Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, U.K.
c Department of Cardiology, Nottingham City Hospital, Nottingham, U.K.
d Health Economics Research Group, Brunel University, Uxbridge, U.K.
e Pre-hospital Emergency Research Unit, University of Wales College of Medicine, Cardiff, U.K.

revised October 22, 2001; accepted November 7, 2001

Abstract

Aims The second Randomized Intervention Treatment of Angina (RITA-2) trial compares an initial strategy of PTCA with continued medical management in patients with arteriographically proven coronary artery disease. This paper employs resource use data collected in the trial to compare the health service costs of the two strategies over 3 years follow-up.

Methods and Results 1018 patients were randomized, 504 to PTCA and 514 to continued medical management. Health service resource use data were collected prospectively on all patients. Hospital unit costs were estimated in collaboration with five U.K. centres. PTCA patients underwent more subsequent coronary arteriograms, but subsequent (non-randomized) PTCAs were more common in patients randomized to medical management (118 procedures in 102 patients) compared to those randomized to PTCA (73 procedures in 62 patients). The likelihood of undergoing CABG was similar in the two groups. The use of antianginal medications was higher in patients randomized to an initial strategy of medical management. There was an overall mean additional cost per patient over 3 years in patients randomized to PTCA of £2685 (95% CI £2074–£3322).

Conclusions In RITA-2, the cost of an initial strategy of PTCA exceeded the cost of an initial strategy of medical management by 74% over 3 years. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Angina, cost analysis, percutaneous transluminal coronary angioplasty

f1 Correspondence: Professor Mark Sculpher, Centre for Health Economics, University of York, Heslington, York YO10 5DD, U.K.

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