Journal article
Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)
European heart journal. Quality of care & clinical outcomes, v 7(5), pp 486-495
01 Nov 2021
PMID: 32407460
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy.
A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy.
Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
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Details
- Title
- Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)
- Creators
- Michelle Samuel - Montreal Heart InstituteJean-Claude Tardif - Montreal Heart InstitutePaul Khairy - Montreal Heart InstituteFrançois Roubille - Centre Hospitalier Universitaire de MontpellierDavid D Waters - San Francisco General HospitalJean C Grégoire - Montreal Heart InstituteFausto J Pinto - University of LisbonAldo P Maggioni - Associazione Nazionale Medici Cardiologi OspedalieriRafael Diaz - Estudios Clínicos LatinoaméricaColin Berry - University of GlasgowWolfgang Koenig - Universität UlmPetr Ostadal - Na Homolce HospitalJose Lopez-Sendon - Universidad Autónoma de MadridHabib Gamra - Hospital Fatuma Bourguiba MonastirGhassan S Kiwan - American University of Beirut Medical CenterMarie-Pierre Dubé - Montreal Heart InstituteMylène Provencher - Montreal Heart InstituteAndreas Orfanos - Institut universitaire de cardiologie et de pneumologie de QuébecLucie Blondeau - Montreal Heart InstituteSimon Kouz - Cegep regional de LanaudierePhilippe L L'Allier - Montreal Heart InstituteReda Ibrahim - Montreal Heart InstituteNadia Bouabdallaoui - Montreal Heart InstituteDominic Mitchell - Centre Hospitalier Universitaire de ToursMarie-Claude Guertin - The Coordinating CenterJacques Lelorier - Centre Hospitalier de l’Université de Montréal
- Publication Details
- European heart journal. Quality of care & clinical outcomes, v 7(5), pp 486-495
- Grant note
- MR/N003403/1 / Medical Research Council CIHR
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000701460000009
- Scopus ID
- 2-s2.0-85116449603
- Other Identifier
- 991022135713604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems