Costs of an early intervention versus a conservative strategy in acute coronary syndrome

BackgroundThe Randomised Intervention Treatment of unstable Angina (RITA-3) found that non-ST-elevation myocardial infarction and unstable angina patients randomised to routine early arteriography experienced a lower rate of death or myocardial infarction than patients randomised to conservative therapy over a five year period of follow up. This paper uses data from the RITA-3 trial to compare the health service costs of the two strategies.MethodsThe resource use data included initial arteriography and revascularisation procedures in the early intervention group and subsequently in both groups; in-patient days in hospital for any reason in the first year of follow-up; incidence of myocardial infarction; and cardiac medication.ResultsAfter five years, the early intervention arm accrued a total mean cost of £11,340 (€15,592) and the conservative arm a mean of £9749(€13,405), an additional mean cost in the intervention arm of £1591 (95% CI £851 to £2276) (€2188; 95%CI €1160 to €3228). On average, costs increased with age and were higher in male patients and in patients with severe angina. However, the incremental cost of the intervention strategy was consistent across different patient sub-groups.ConclusionOver a period of 5 years, the initial additional cost of a strategy of early intervention is only partially offset by subsequent interventions in patients managed conservatively.