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Samuel M, Tardif JC, Khairy P, et al. Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J Qual Care Clin Outcomes. 2021;7(5):486-495doi: 10.1093/ehjqcco/qcaa045.
Samuel, M., Tardif, J. C., Khairy, P., Roubille, F., Waters, D. D., Grégoire, J. C., Pinto, F. J., Maggioni, A. P., Diaz, R., Berry, C., Koenig, W., Ostadal, P., Lopez-Sendon, J., Gamra, H., Kiwan, G. S., Dubé, M. P., Provencher, M., Orfanos, A., Blondeau, L., Kouz, S., L'Allier, P. L., Ibrahim, R., Bouabdallaoui, N., Mitchell, D., Guertin, M. C., & Lelorier, J. (2021). Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). European heart journal. Quality of care & clinical outcomes, 7(5), 486-495. https://doi.org/10.1093/ehjqcco/qcaa045
Samuel, Michelle, et al. "Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)." European heart journal. Quality of care & clinical outcomes vol. 7,5 (2021): 486-495. doi: https://doi.org/10.1093/ehjqcco/qcaa045
Samuel M, Tardif JC, Khairy P, Roubille F, Waters DD, Grégoire JC, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Ostadal P, Lopez-Sendon J, Gamra H, Kiwan GS, Dubé MP, Provencher M, Orfanos A, Blondeau L, Kouz S, L'Allier PL, Ibrahim R, Bouabdallaoui N, Mitchell D, Guertin MC, Lelorier J. Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):486-495. doi: 10.1093/ehjqcco/qcaa045. PMID: 32407460; PMCID: PMC8445085.
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Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):486-495. doi: 10.1093/ehjqcco/qcaa045.

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

European heart journal. Quality of care & clinical outcomes

Michelle Samuel, Jean-Claude Tardif, Paul Khairy, François Roubille, David D Waters, Jean C Grégoire, Fausto J Pinto, Aldo P Maggioni, Rafael Diaz, Colin Berry, Wolfgang Koenig, Petr Ostadal, Jose Lopez-Sendon, Habib Gamra, Ghassan S Kiwan, Marie-Pierre Dubé, Mylène Provencher, Andreas Orfanos, Lucie Blondeau, Simon Kouz, Philippe L L'Allier, Reda Ibrahim, Nadia Bouabdallaoui, Dominic Mitchell, Marie-Claude Guertin, Jacques Lelorier

Affiliations

  1. Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, Québec H1T 1C8, Canada.
  2. Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France.
  3. San Francisco General Hospital, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
  4. 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.
  5. ANMCO Research Center, Via La Marmora 34, 50121 Firenze, Italy.
  6. Estudios Clinicos Latinoamerica, Paraguay 160, 2000, Rosario, Argentina.
  7. University of Glasgow and NHS Glasgow Clinical Research Facility, 126 University Pl, University of Glasgow, Glasgow, G12 8TA, Scotland, UK.
  8. Deutsches Herzzentrum München, Technische Universität München, Munich, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Lazarettstr. 36, D-80636 Munchen, Germany.
  9. Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 150 00 Prague, Czech Republic.
  10. H La Paz, IdiPaz, UAM, Ciber-CV Madrid, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain.
  11. Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.
  12. Bellevue Medical Center, Qanater Zubayda- Mansouriyeh, Mansourieh, Metn District, Beirut, Lebanon.
  13. The Montreal Health Innovations Coordinating Center, 4100 Molson St. Suite 400 Montreal, Quebec H1Y 3N1, Canada.
  14. Centre Hospitalier Régional de Lanaudière, 1000 Sainte-Anne Blvd Saint-Charles-Borromée, Quebec J6E 6J2, Canada.
  15. Logimetrix Inc., 3600 Rhodes Drive Windsor, Ontario N8W 5A4, Canada.
  16. Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St Denis St Montreal, Quebec H2X 0A9, Canada.

PMID: 32407460 PMCID: PMC8445085 DOI: 10.1093/ehjqcco/qcaa045

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.

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords: Colchicine; Cost effectiveness;  Myocardial infarction

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