COST-ANALYSIS OF ONCE-DAILY ISMN VERSUS TWICE-DAILY ISMN OR TRANSDERMAL PATCH FOR NITRATE PROPHYLAXIS

Objective: To compare the costs and outcomes of treating exercise-indu ced angina with once-or twice-daily isosorbide mononitrate (ISMN) or t ransdermal patch. Method: A decision-analytic model was designed based on published literature showing compliance and increasing symptoms an d estimates from physicians on treatment patterns and worsening sympto ms. Results: Data show that patients are more compliant with once-dail y ISMN (Imdur(R), Astra Hassle, Molndal, Sweden) and patch regimens th an with twice-daily dose. Based upon the assumption that more complian t patients are better controlled, the model found that fewer medical c are resources were consumed by patients treated with the once-daily an d the patch regimens. The unit cost of the twice-daily ISMN regimen is 40% of the unit cost of the once-daily. Annual costs of treating an e xercise-induced angina patient are pound 248 for Imdur(R) compared to pound 250 for the twice-daily ISMN and pound 299 for the transdermal p atch. Conclusion: Unit prices alone are not good indicators for estima ting medical management costs.