Congratulations! You have just been appointed as the member of the formulary committee of a large teaching hospital in Sydney, Australia. A key item on the agenda of the next meeting is a proposal to implement a management protocol for the treatment of acute myocardial infraction. You have been asked to evaluate two available evidence and present to the committee as to which of two available drugs represents the more cost- effective choice.
The draft clinical management protocol currently proposes the use of the (hypothetical) thrombolytic drug Thrombase. A new drug, Klotgon, has been recently been brought to your attention. The two drugs have been compared in a large randomised trial in which the primary outcome of mortality was measured 30 days after randomization.
Outcome in 100 patients
| No treatment | 15 deaths | |
| Thrombase | 10 deaths | |
| Klotgon | 7 deaths | |
| Thrombase | Drug cost per patient | $ 200 |
| Klotgon | $ 1,000 |
You are also aware that the average survival following non-fatal myocardial infraction is 8 years.
1. If the hospital’s budget for purchasing thrombolytics was $200,000, how many patients could be treated, and how many additional lives could be saved with each drug, compared with no treatment at all?
2. If the hospital’s budget was unlimited, and if 1,000 patients were to be treated, how many lives could be saved if patients were treated with Thrombase, compared with no treatment? How many could be saved with Klotgon, compared with no treatment?
3. Using the same 1000 patients, calculate the incremental cost per death avoided, for each of the thrombolytic agents, compared with no active treatment?
Remember ‘incremental’ just means ‘difference’. So the incremental cost is just the
difference in cost between the two treatment options.
(Hint: Deaths avoided is the same as lives saved, which you have already calculated in Q2). Incremental cost effectiveness ratio (ICER) = Total cost new – Total cost comparator
Total benefit new – Total benefit comparator
4. Using the same 1000 patients, what are the incremental cost-effectiveness ratios
(ICERs), expressed as the incremental cost per life-year gained, for each of the thrombolytic agents, compared with no active treatment?
5. Using the same 1000 patients, calculate the incremental cost per life-year gained for
Klotgon, compared to Thrombase? (Hint: you need to use the formula above)
6. What will you recommend to the formulary committee, and why?
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