RESUMEN
AIMS: Recent trials have shown that low-dose colchicine (0.5 mg once daily) reduces major cardiovascular events in patients with acute and chronic coronary syndromes. We aimed to estimate the cost-effectiveness of low-dose colchicine therapy in patients with chronic coronary disease when added to standard background therapy. METHODS AND RESULTS: This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, costs and quality of life obtained from the Low-dose Colchicine 2 (LoDoCo2) trial, as well as meta-analyses and public sources. In this trial, Low-dose colchicine was added to standard of care and compared to placebo. The main outcomes were cardiovascular events including myocardial infarction, stroke and coronary revascularisation, quality-adjusted life-year (QALY), the cost per QALY gained (incremental cost-effectiveness ratio), and net monetary benefit. In the model, low-dose colchicine therapy yielded 0.04 additional QALYs compared with standard of care at an incremental cost of 455 from a societal perspective and 729 from a healthcare perspective, resulting in a cost per QALY gained of 12,176/QALY from a societal perspective and 19,499/QALY from a healthcare perspective. Net monetary benefit was 1,414 from a societal perspective and 1,140 from a healthcare perspective. Low-dose colchicine has a 96% and 94% chance of being cost effective, from respectively a societal and healthcare perspective when using a willingness to pay of 50,000/QALY. Net monetary benefit would decrease below zero when annual low-dose colchicine costs would exceed an annual cost of 221 per patient. CONCLUSION: Adding low-dose colchicine to standard of care in patients with chronic coronary disease is cost-effective according to commonly accepted thresholds in Europe and Australia and compares favourably in cost-effectiveness to other drugs used in chronic coronary disease.
RESUMEN
Raman spectroscopy can provide detailed, quantitative information about the chemical composition of an atherosclerotic plaque. Recent development of compact clinical Raman systems and specially developed Raman catheters allow the remote, intravascular application of the technique. This shows prospects for the detection of coronary plaques that are prone to rupture and for the quantitative study of atherosclerosis in terms of chemical composition. This review discusses the basic principles and advances of Raman spectroscopy in the field of atherosclerosis, and its future directions in cardiovascular medicine.
