Skip to main content
Top
Published in: BMC Health Services Research 1/2015

Open Access 01-06-2015 | Research article

Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study

Authors: Georgia Kourlaba, Charalambos Vlachopoulos, John Parissis, John Kanakakis, George Gourzoulidis, Nikos Maniadakis

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece.

Methods

A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The cost inputs considered in the model reflect drug acquisition, hospitalizations, vascular interventions and monitoring of patients. The resource utilization data were obtained from 3 local experts. All costs refer to the year 2014. Cost-effectiveness was assessed by means of the incremental cost per quality adjusted life year (QALY) gained with the ranolazine as add-on therapy relative to SoC alone (ICER). Probabilistic sensitivity analysis (PSA) was performed.

Results

Ranolazine as add-on therapy was more costly compared to SoC alone, as the 6-month total cost per patient was €1170 and € 984, respectively. Patients received ranolazine plus SoC and SoC alone gained 0.3155 QALYs and 0.2752 QALYs, respectively. Ranolazine plus SoC resulted in an ICER equal to €4620 per QALY gained, well below the threshold of €34,000 per QALY gained. The PSA showed that the likelihood of ranolazine plus SoC being cost-effective at the threshold of €34,000 per QALY gained was 100 %.

Conclusions

Τhe results suggest that ranolazine as add–on treatment may be a cost-effective alternative for the symptomatic treatment of patients with chronic stable angina in Greece.
Appendix
Available only for authorised users
Literature
2.
go back to reference Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: the task force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J. 2006;27(11):1341–81.PubMedCrossRef Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: the task force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J. 2006;27(11):1341–81.PubMedCrossRef
3.
go back to reference Spertus JA, Jones P, McDonell M, Fan V, Fihn SD. Health status predicts long-term outcome in outpatients with coronary disease. Circulation. 2002;106(1):43–9.PubMedCrossRef Spertus JA, Jones P, McDonell M, Fan V, Fihn SD. Health status predicts long-term outcome in outpatients with coronary disease. Circulation. 2002;106(1):43–9.PubMedCrossRef
4.
go back to reference Arnold SV, Morrow DA, Lei Y, Cohen DJ, Mahoney EM, Braunwald E, et al. Economic impact of angina after an acute coronary syndrome: insights from the MERLIN-TIMI 36 trial. Circ Cardiovasc Qual Outcomes. 2009;2(4):344–53.PubMedCrossRef Arnold SV, Morrow DA, Lei Y, Cohen DJ, Mahoney EM, Braunwald E, et al. Economic impact of angina after an acute coronary syndrome: insights from the MERLIN-TIMI 36 trial. Circ Cardiovasc Qual Outcomes. 2009;2(4):344–53.PubMedCrossRef
5.
go back to reference Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJ. The current cost of angina pectoris to the National Health Service in the UK. Heart. 2003;89(8):848–53.PubMedCentralPubMedCrossRef Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJ. The current cost of angina pectoris to the National Health Service in the UK. Heart. 2003;89(8):848–53.PubMedCentralPubMedCrossRef
6.
go back to reference Kempf J, Buysman E, Brixner D. Health resource utilization and direct costs associated with angina for patients with coronary artery disease in a US managed care setting. Am Health Drug Benefits. 2011;4(6):353–61.PubMedCentralPubMed Kempf J, Buysman E, Brixner D. Health resource utilization and direct costs associated with angina for patients with coronary artery disease in a US managed care setting. Am Health Drug Benefits. 2011;4(6):353–61.PubMedCentralPubMed
7.
go back to reference Reynolds MW, Frame D, Scheye R, Rose ME, George S, Watson JB, et al. A systematic review of the economic burden of chronic angina. Am J Manag Care. 2004;10(11 Suppl):S347–57.PubMed Reynolds MW, Frame D, Scheye R, Rose ME, George S, Watson JB, et al. A systematic review of the economic burden of chronic angina. Am J Manag Care. 2004;10(11 Suppl):S347–57.PubMed
8.
go back to reference Andrikopoulos G, Parissis J, Filippatos G, Nikolaou M, Pantos K, Voudris V, et al. Medical management of stable angina. Hellenic J Cardiol. 2014;55(4):272–80.PubMed Andrikopoulos G, Parissis J, Filippatos G, Nikolaou M, Pantos K, Voudris V, et al. Medical management of stable angina. Hellenic J Cardiol. 2014;55(4):272–80.PubMed
9.
go back to reference Gayet JL, Paganelli F, Cohen-Solal A. Update on the medical treatment of stable angina. Arch Cardiovasc Dis. 2011;104(10):536–44.PubMedCrossRef Gayet JL, Paganelli F, Cohen-Solal A. Update on the medical treatment of stable angina. Arch Cardiovasc Dis. 2011;104(10):536–44.PubMedCrossRef
10.
go back to reference Tarkin JM, Kaski JC. Pharmacological treatment of chronic stable angina pectoris. Clin Med. 2013;13(1):63–70.CrossRef Tarkin JM, Kaski JC. Pharmacological treatment of chronic stable angina pectoris. Clin Med. 2013;13(1):63–70.CrossRef
11.
go back to reference Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–16.PubMedCrossRef Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–16.PubMedCrossRef
12.
go back to reference Keating GM. Ranolazine: a review of its use as add-on therapy in patients with chronic stable angina pectoris. Drugs. 2013;73(1):55–73.PubMedCrossRef Keating GM. Ranolazine: a review of its use as add-on therapy in patients with chronic stable angina pectoris. Drugs. 2013;73(1):55–73.PubMedCrossRef
13.
go back to reference Borer JS, Fox K, Jaillon P, Lerebours G, Ivabradine Investigators G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation. 2003;107(6):817–23.PubMedCrossRef Borer JS, Fox K, Jaillon P, Lerebours G, Ivabradine Investigators G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation. 2003;107(6):817–23.PubMedCrossRef
14.
go back to reference Chaitman BR, Ivleva AY, Ujda M, Lenis JH, Toth C, Stieber DM, et al. Antianginal efficacy of omapatrilat in patients with chronic angina pectoris. Am J Cardiol. 2005;95(11):1283–9.PubMedCrossRef Chaitman BR, Ivleva AY, Ujda M, Lenis JH, Toth C, Stieber DM, et al. Antianginal efficacy of omapatrilat in patients with chronic angina pectoris. Am J Cardiol. 2005;95(11):1283–9.PubMedCrossRef
15.
go back to reference Tardif JC, Ford I, Tendera M, Bourassa MG, Fox K, Investigators I. Efficacy of ivabradine, a new selective I(f) inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26(23):2529–36.PubMedCrossRef Tardif JC, Ford I, Tendera M, Bourassa MG, Fox K, Investigators I. Efficacy of ivabradine, a new selective I(f) inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26(23):2529–36.PubMedCrossRef
16.
go back to reference Vicari RM, Chaitman B, Keefe D, Smith WB, Chrysant SG, Tonkon MJ, et al. Efficacy and safety of fasudil in patients with stable angina: a double-blind, placebo-controlled, phase 2 trial. J Am Coll Cardiol. 2005;46(10):1803–11.PubMedCrossRef Vicari RM, Chaitman B, Keefe D, Smith WB, Chrysant SG, Tonkon MJ, et al. Efficacy and safety of fasudil in patients with stable angina: a double-blind, placebo-controlled, phase 2 trial. J Am Coll Cardiol. 2005;46(10):1803–11.PubMedCrossRef
17.
go back to reference Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J, et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA. 2004;291(3):309–16.PubMedCrossRef Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J, et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA. 2004;291(3):309–16.PubMedCrossRef
18.
go back to reference Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J, et al. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004;43(8):1375–82.PubMedCrossRef Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J, et al. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004;43(8):1375–82.PubMedCrossRef
19.
go back to reference Song Y, Shryock JC, Wu L, Belardinelli L. Antagonism by ranolazine of the pro-arrhythmic effects of increasing late INa in guinea pig ventricular myocytes. J Cardiovasc Pharmacol. 2004;44(2):192–9.PubMedCrossRef Song Y, Shryock JC, Wu L, Belardinelli L. Antagonism by ranolazine of the pro-arrhythmic effects of increasing late INa in guinea pig ventricular myocytes. J Cardiovasc Pharmacol. 2004;44(2):192–9.PubMedCrossRef
20.
go back to reference Wu L, Shryock JC, Song Y, Li Y, Antzelevitch C, Belardinelli L. Antiarrhythmic effects of ranolazine in a guinea pig in vitro model of long-QT syndrome. J Pharmacol Exp Ther. 2004;310(2):599–605.PubMedCrossRef Wu L, Shryock JC, Song Y, Li Y, Antzelevitch C, Belardinelli L. Antiarrhythmic effects of ranolazine in a guinea pig in vitro model of long-QT syndrome. J Pharmacol Exp Ther. 2004;310(2):599–605.PubMedCrossRef
22.
go back to reference Stone PH, Gratsiansky NA, Blokhin A, Huang IZ, Meng L, Investigators E. Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (Efficacy of Ranolazine in Chronic Angina) trial. J Am Coll Cardiol. 2006;48(3):566–75.PubMedCrossRef Stone PH, Gratsiansky NA, Blokhin A, Huang IZ, Meng L, Investigators E. Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (Efficacy of Ranolazine in Chronic Angina) trial. J Am Coll Cardiol. 2006;48(3):566–75.PubMedCrossRef
23.
go back to reference Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Murphy SA, Budaj A, Varshavsky S, et al. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA. 2007;297(16):1775–83.PubMedCrossRef Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Murphy SA, Budaj A, Varshavsky S, et al. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA. 2007;297(16):1775–83.PubMedCrossRef
24.
go back to reference Hidalgo-Vega A, Ramos-Goni JM, Villoro R. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain. Eur J Health Econ. 2013;15(9):917–25.CrossRef Hidalgo-Vega A, Ramos-Goni JM, Villoro R. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain. Eur J Health Econ. 2013;15(9):917–25.CrossRef
25.
go back to reference Arnold SV, Morrow DA, Wang K, Lei Y, Mahoney EM, Scirica BM, et al. Effects of ranolazine on disease-specific health status and quality of life among patients with acute coronary syndromes: results from the MERLIN-TIMI 36 randomized trial. Circ Cardiovasc Qual Outcomes. 2008;1(2):107–15.PubMedCrossRef Arnold SV, Morrow DA, Wang K, Lei Y, Mahoney EM, Scirica BM, et al. Effects of ranolazine on disease-specific health status and quality of life among patients with acute coronary syndromes: results from the MERLIN-TIMI 36 randomized trial. Circ Cardiovasc Qual Outcomes. 2008;1(2):107–15.PubMedCrossRef
26.
go back to reference Etemad LR, McCollam PL. Total first-year costs of acute coronary syndrome in a managed care setting. J Manag Care Pharm. 2005;11(4):300–6.PubMed Etemad LR, McCollam PL. Total first-year costs of acute coronary syndrome in a managed care setting. J Manag Care Pharm. 2005;11(4):300–6.PubMed
27.
go back to reference Longworth L, Buxton MJ, Sculpher M, Smith DH. Estimating utility data from clinical indicators for patients with stable angina. Eur J Health Econ. 2005;6(4):347–53.PubMedCrossRef Longworth L, Buxton MJ, Sculpher M, Smith DH. Estimating utility data from clinical indicators for patients with stable angina. Eur J Health Econ. 2005;6(4):347–53.PubMedCrossRef
28.
go back to reference Karwatowska-Prokopczuk E, Wang W, Cheng ML, Zeng D, Schwartz PJ, Belardinelli L. The risk of sudden cardiac death in patients with non-ST elevation acute coronary syndrome and prolonged QTc interval: effect of ranolazine. Europace. 2013;15(3):429–36.PubMedCrossRef Karwatowska-Prokopczuk E, Wang W, Cheng ML, Zeng D, Schwartz PJ, Belardinelli L. The risk of sudden cardiac death in patients with non-ST elevation acute coronary syndrome and prolonged QTc interval: effect of ranolazine. Europace. 2013;15(3):429–36.PubMedCrossRef
29.
go back to reference Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle angina questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25(2):333–41.PubMedCrossRef Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle angina questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25(2):333–41.PubMedCrossRef
34.
go back to reference Briggs A, Claxton K, Sculpher M. Decision modelling for health economic evaluation. In: Gray A, Briggs A, editors. Handbooks in health economic evaluation. 2006. Briggs A, Claxton K, Sculpher M. Decision modelling for health economic evaluation. In: Gray A, Briggs A, editors. Handbooks in health economic evaluation. 2006.
35.
go back to reference Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med. 2000;19(23):3219–36.PubMedCrossRef Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med. 2000;19(23):3219–36.PubMedCrossRef
36.
go back to reference Kohn CG, Parker MW, Limone BL, Coleman CI. Cost-effectiveness of ranolazine added to standard-of-care treatment in patients with chronic stable angina pectoris. Am J Cardiol. 2014;113(8):1306–11.PubMedCrossRef Kohn CG, Parker MW, Limone BL, Coleman CI. Cost-effectiveness of ranolazine added to standard-of-care treatment in patients with chronic stable angina pectoris. Am J Cardiol. 2014;113(8):1306–11.PubMedCrossRef
37.
go back to reference Gorokhova SG. ea. Cost-effectiveeness of ranolazIne for the treatment of angIna Pectoris in RussIa. Value Health. 2014;17:A323–686.CrossRef Gorokhova SG. ea. Cost-effectiveeness of ranolazIne for the treatment of angIna Pectoris in RussIa. Value Health. 2014;17:A323–686.CrossRef
38.
go back to reference Phelps CE, Buysman EK, Gomez RG. Costs and clinical outcomes associated with use of ranolazine for treatment of angina. Clin Ther. 2012;34(6):1395–407.e4.PubMedCrossRef Phelps CE, Buysman EK, Gomez RG. Costs and clinical outcomes associated with use of ranolazine for treatment of angina. Clin Ther. 2012;34(6):1395–407.e4.PubMedCrossRef
Metadata
Title
Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study
Authors
Georgia Kourlaba
Charalambos Vlachopoulos
John Parissis
John Kanakakis
George Gourzoulidis
Nikos Maniadakis
Publication date
01-06-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1228-y

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue