Medical Journal of The Islamic Republic of Iran (MJIRI)
Iran University of Medical Sciences
Thu, Nov 21, 2024
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Volume 34, Issue 1 (2-2020)
Med J Islam Repub Iran 2020 |
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Rezapour A, Tavakoli N, Akbari S, Hajahmadi M, Ameri H, Mohammadi R et al . Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis. Med J Islam Repub Iran 2020; 34 (1) :1062-1067
URL: http://mjiri.iums.ac.ir/article-1-6301-en.html
URL: http://mjiri.iums.ac.ir/article-1-6301-en.html
Aziz Rezapour 
, Nader Tavakoli , Sadaf Akbari , Marjan Hajahmadi , Hosein Ameri , Reza Mohammadi , Saeed Bagheri Faradonbeh
, Nader Tavakoli , Sadaf Akbari , Marjan Hajahmadi , Hosein Ameri , Reza Mohammadi , Saeed Bagheri Faradonbeh
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran , bagheri.s@iums.ac.ir
Abstract: (1852 Views)
Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease.
Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses.
Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain.
Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses.
Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain.
Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
Keywords: Medical therapy, Percutaneous coronary intervention, Ischemic heart disease, Cost-effectiveness analysis
Type of Study: Original Research |
Subject:
Health Management and Economics
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