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Adawan Permpanich, Vithaya Kulsomboon and Kamol Udol

Abstract

Background

Acute myocardial infarction (MI) is a leading cause of cardiovascular (CV) mortality and hospitalization. Survivors of acute MI have higher risk of subsequent CV events and death, compared to individuals without MI. Evidences have demonstrated the CV benefits of n-3 polyunsaturated fatty acids (PUFAs) in patients who experienced MI.

Objectives

We assessed the cost-effectiveness of highly concentrated n-3 polyunsaturated fatty acids (PUFAs) in addition to standard therapy compared with standard therapy alone in post-MI patients in Thailand.

Methods

A Markov model was constructed to assess costs, life years, and quality-adjusted life years (QALYs) with lifetime horizon in post-MI patients, on the basis of provider perspective. Input data were based on information from the Thai Acute Coronary Syndrome (ACS) Registry, a meta-analysis of mortality data and published articles. Outcomes have been presented as incremental cost-effectiveness ratios of life expectancy and quality-adjusted life expectancy. Deterministic and probabilistic sensitivity analyses were performed for key variables in the model.

Results

n-3 PUFAs increased life expectancy by 2.34 life-years at an incremental cost-effectiveness ratio (ICER) of 256,199 Thai baht (THB) per life-year gained (LYG), compared to the standard therapy alone in the base case analysis. The quality-adjusted life years (QALY) increased by 2.01 with ICER of 297,193 THB per QALY from n-3 PUFAs supplementation. Both ICER/QALY and ICER/LYG decreased as the age of patients increased. The incremental cost per QALY gained in post-MI patients aged 45 to 85 years old ranged from 216,200 THB to 414,049 THB.

Conclusion

Considering the current willingness-to-pay threshold of 160,000 THB/QALY, highly concentrated n-3 PUFAs as secondary prevention of MI appears not to be cost-effective compared to standard treatment alone in Thailand.