Cost effectiveness of treatments for non-ST-segment elevation acute coronary syndrome.

Background: Acute coronary syndrome (ACS) represents the most common subset of cardiovascular heart diseases and relates to high rates of morbidity and mortality worldwide and, consequently, to both the direct and indirect costs to the health system and society. Given the rising healthcare costs combined with budgetary constraints, health care systems and decision makers are faced with challenging decisions and the need to choose alternative treatments that not only improve patient quantity and quality of life but are also economically attractive.

Objectives: To systematically review the published literature and to identify studies evaluating the cost effectiveness of different treatments for patients presenting with non-ST-segment elevation (NSTE) ACS.

Data Sources: A literature search was performed using PubMed and the Cochrane Library until October 2013, with no limit on publication date.

Study Selection: The search was conducted using predetermined inclusion and exclusion criteria, limiting articles to those published in the English language and those reporting results of economic evaluations [i.e. cost-effectiveness (CEA), cost-utility (CUA) cost-minimisation (CMA) cost-consequence (CCA) and cost-benefit (CBA) analyses] of the different treatment therapies used for managing patients presenting with NSTE-ACS. Publications such as editorials, letters to the editor, posters, expert opinions, reviews, systematic reviews, or meta-analyses were excluded.

Study Appraisal Methods: All studies included were assessed for their methodological quality using the British Medical Journal checklist.

Results: A total of 39 studies were included, presenting a wide variation in terms of methodological approaches and settings, thus resulting in different ranges of incremental cost-effectiveness ratios for each treatment evaluated.

Conclusions: Evidence from the present systematic review suggests that the majority of the available treatments represent either cost-saving or cost-effective options for NSTE-ACS patients. Moreover, the cost effectiveness of the available treatments was found to be dependent on various factors, particularly the risk profile of patients and the cost of treatment, and hence there is a need to take these into consideration when making decisions and choices.