Systematic review, meta-analysis and economic modelling of ...

DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1general population (without MI) was estimated from the Office for National Statistics 158 and the generalpopulation utilities are estimated from Ara et al. 15 which included different utilities for men and women.Sensitivity analysis was also performed using utility values from Ara et al., 159 which included differentutilities for men and women. It should also be noted that the utilities were not capped at the populationmeans as this was a minor issue and is only relevant for people aged > 90 years. The estimated QALYpay-offs for patients with MI and reinfarction are outlined in Table 37, whereas the age-specific QALYs forthe general population are reported in Appendix 5.CostsThe costs included in the model are:1. all biomarker measurement costs2. hospital stay as determined by the strategy3. treatments administered4. subsequent cardiac events5. lifetime costs of care for patients with CAD.We assumed that patients would incur costs whenever a test was performed and the costs of biomarkerswere estimated from the RATPAC trial data, 160 with all of them around £20. In the case of multiplebiomarker strategies, the costs of each biomarker are added.The patients also accrued costs proportional to their length of hospital stay. It was assumed that any timespent in hospital incurred costs at the rate for admission to a general medical ward, regardless of theirlocation in the hospital. This was because per diem costs for different locations reflected different types ofTABLE 36 Probability of reinfarction or death up to 1 year after MISource Estimate (%) DistributionDeathTreated MI Mills 155 11 n/N = 9/80Untreated MI Mills 155 21 n/N = 19/90Patients with no MI Mills 155 1 n/N = 4/402ReinfarctionTreated MI Mills 155 11 n/N = 9/80Untreated MI Mills 155 29 n/N = 26/90Patients with no MI Mills 155 3.9 n/N = 17/440TABLE 37 Lifetime QALYs of patients with MI and with reinfarctionQALYsAge (years)MIMI withreinfarction30–44 12.20 9.7645–54 9.47 7.5855–64 6.73 5.3965–74 4.65 3.72> 75 2.43 1.95© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.87