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      Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)

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          Abstract

          Aims

          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.

          Methods and results

          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.

          Conclusion

          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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          Most cited references23

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          Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

          Circulation, 139(10)
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            Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction

            Experimental and clinical evidence supports the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis.
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              Prasugrel versus clopidogrel in patients with acute coronary syndromes.

              Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention. To compare prasugrel, a new thienopyridine, with clopidogrel, we randomly assigned 13,608 patients with moderate-to-high-risk acute coronary syndromes with scheduled percutaneous coronary intervention to receive prasugrel (a 60-mg loading dose and a 10-mg daily maintenance dose) or clopidogrel (a 300-mg loading dose and a 75-mg daily maintenance dose), for 6 to 15 months. The primary efficacy end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The key safety end point was major bleeding. The primary efficacy end point occurred in 12.1% of patients receiving clopidogrel and 9.9% of patients receiving prasugrel (hazard ratio for prasugrel vs. clopidogrel, 0.81; 95% confidence interval [CI], 0.73 to 0.90; P<0.001). We also found significant reductions in the prasugrel group in the rates of myocardial infarction (9.7% for clopidogrel vs. 7.4% for prasugrel; P<0.001), urgent target-vessel revascularization (3.7% vs. 2.5%; P<0.001), and stent thrombosis (2.4% vs. 1.1%; P<0.001). Major bleeding was observed in 2.4% of patients receiving prasugrel and in 1.8% of patients receiving clopidogrel (hazard ratio, 1.32; 95% CI, 1.03 to 1.68; P=0.03). Also greater in the prasugrel group was the rate of life-threatening bleeding (1.4% vs. 0.9%; P=0.01), including nonfatal bleeding (1.1% vs. 0.9%; hazard ratio, 1.25; P=0.23) and fatal bleeding (0.4% vs. 0.1%; P=0.002). In patients with acute coronary syndromes with scheduled percutaneous coronary intervention, prasugrel therapy was associated with significantly reduced rates of ischemic events, including stent thrombosis, but with an increased risk of major bleeding, including fatal bleeding. Overall mortality did not differ significantly between treatment groups. (ClinicalTrials.gov number, NCT00097591 [ClinicalTrials.gov].) Copyright 2007 Massachusetts Medical Society.
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                Author and article information

                Contributors
                Journal
                Eur Heart J Qual Care Clin Outcomes
                Eur Heart J Qual Care Clin Outcomes
                ehjqcco
                European Heart Journal. Quality of Care & Clinical Outcomes
                Oxford University Press
                2058-5225
                2058-1742
                November 2021
                14 May 2020
                14 May 2020
                : 7
                : 5
                : 486-495
                Affiliations
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Université de Montpellier, INSERM, CNRS, CHU de Montpellier , Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France
                San Francisco General Hospital , Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Santa Maria University Hospital (Centro Hospitalar Universitário Lisboa Norte), Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisbon , Portugal
                ANMCO Research Center , Via La Marmora 34, 50121 Firenze, Italy
                Estudios Clinicos Latinoamerica , Paraguay 160, 2000, Rosario, Argentina
                University of Glasgow and NHS Glasgow Clinical Research Facility , 126 University Pl, University of Glasgow, Glasgow, G12 8TA, Scotland, UK
                Deutsches Herzzentrum München, Technische Universität München, Munich, Institute of Epidemiology and Medical Biometry, University of Ulm , Ulm, Lazarettstr. 36, D-80636 Munchen, Germany
                Cardiovascular Center, Na Homolce Hospital , Roentgenova 2, 150 00 Prague, Czech Republic
                H La Paz, IdiPaz, UAM, Ciber-CV Madrid , La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
                Fattouma Bourguiba University Hospital , 5000 Monastir, Tunisia
                Bellevue Medical Center , Qanater Zubayda- Mansouriyeh, Mansourieh, Metn District, Beirut, Lebanon
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                The Montreal Health Innovations Coordinating Center , 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
                The Montreal Health Innovations Coordinating Center , 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
                The Montreal Health Innovations Coordinating Center , 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
                Centre Hospitalier Régional de Lanaudière , 1000 Sainte-Anne Blvd Saint-Charles-Borromée, Quebec J6E 6J2, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Logimetrix Inc. , 3600 Rhodes Drive Windsor, Ontario N8W 5A4, Canada
                The Montreal Health Innovations Coordinating Center , 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada
                Montreal Heart Institute , Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada
                Centre de recherche du Centre hospitalier de l’Université de Montréal , 900 St Denis St Montreal, Quebec H2X 0A9, Canada
                Author notes
                Corresponding author. Tel: 514 376-3330, Email: jean-claude.tardif@ 123456icm-mhi.org
                Author information
                https://orcid.org/0000-0002-8200-8983
                Article
                qcaa045
                10.1093/ehjqcco/qcaa045
                8445085
                32407460
                44704b66-3e41-4f1f-b723-098b07c44e3d
                © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 08 April 2020
                : 03 May 2020
                : 07 May 2020
                Page count
                Pages: 10
                Funding
                Funded by: Canadian Institutes of Health Research, DOI 10.13039/501100000024;
                Funded by: Montreal Heart Institute, DOI 10.13039/501100012679;
                Categories
                Original Article
                AcademicSubjects/MED00200

                 myocardial infarction,cost effectiveness,colchicine

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