Cost-effectiveness analysis of n-3 polyunsaturated fatty acids (PUFA) after myocardial infarction - Results from Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)-Prevenzione Trial

Objective: To estimate the cost effectiveness of treatment with n-3 polyunsaturated fatty acids (PUFA) for secondary prevention after myocardial infarction (MI). Design and setting: The cost-effectiveness analysis of n-3 PUFA treatment after MI was based on morbidity and mortality data and the use of resources obtained prospectively during the 3.5 year follow-up period of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)-Prevenzione study. The cost-effectiveness analysis took into account the incremental number of lift-years gained and the incremental costs for hospital admissions, diagnostic tests and drugs, applying a 5% discount rate. The value for money of n-3 PUFA treatment was assessed using the cost-effectiveness ratio and the number needed to treat (NNT) approach. Perspective: Third-party payer. Main outcome measures and results: The incremental cost-effectiveness ratio for n-3 PUFA in the basecase scenario was 24 603 euro (EUR, 1999 values) per life-year gained (95% confidence interval: 22 646 to 26 930). Sensitivity analysis included the analysis of extremes, producing estimates varying from EUR 15 721 to EUR52 524 per life year gained. 172 patients would need to be treated per year with n-3 PUFA, at an annual cost of EUR68 000, in order to save 1 patient. This is comparable with the NNT value, and associated annual cost for simvastatin, but less costly than that for pravastatin. Conclusions: The cost effectiveness of long term treatment with n-3 PUFA is comparable with other drugs recently introduced in the routine care of secondary prevention after MI. Since the clinical benefit provided by n-3 PUFA is additive, this therapy should be added to the established routine practice, with additive costs.