Cost-effectiveness of low-dose colchicine in patients with chronic coronary disease in the netherlands

Aernoud T L Fiolet; Willem Keusters; Johan Blokzijl; S Mark Nidorf; John E Eikelboom; Charley A Budgeon; Jan G P Tijssen; Tjeerd Römer; Iris Westendorp; Jan Hein Cornel; Peter L Thompson; Geert W J Frederix; Arend Mosterd; G Ardine de Wit

doi:10.1093/ehjqcco/qcae021

Cost-effectiveness of low-dose colchicine in patients with chronic coronary disease in the netherlands

Eur Heart J Qual Care Clin Outcomes. 2024 Mar 14:qcae021. doi: 10.1093/ehjqcco/qcae021. Online ahead of print.

Authors

Aernoud T L Fiolet^{1

2}, Willem Keusters³, Johan Blokzijl⁴, S Mark Nidorf^{5

6}, John E Eikelboom⁷, Charley A Budgeon⁸, Jan G P Tijssen^{9

10}, Tjeerd Römer¹¹, Iris Westendorp^{12

13}, Jan Hein Cornel^{2

14

15}, Peter L Thompson^{5

6

16}, Geert W J Frederix¹⁷, Arend Mosterd^{2

18}, G Ardine de Wit^{17

19

20}

Affiliations

¹ Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
² Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands.
³ Department of Data Science, Dutch Healthcare Authority, Utrecht, The Netherlands.
⁴ Physical Therapy Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁵ Heart and Vascular Research Institute of Western Australia, Perth, Australia.
⁶ GenesisCare Western Australia, Perth, Australia.
⁷ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ University of Western Australia, Perth, Australia.
⁹ Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
¹⁰ Cardialysis BV, Rotterdam, The Netherlands.
¹¹ Department of Cardiology, Alrijne Hospital, Leiden, The Netherlands.
¹² Cardiology Center Netherlands, IJmuide, The Netherlands.
¹³ Department of Cardiology, Redd Cross Hospital, Beverwijk, The Netherlands.
¹⁴ Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
¹⁵ Department of Cardiology, Radboudumc, Nijmegen, The Netherlands.
¹⁶ Sir Charles Gairdner Hospital, Perth, Australia.
¹⁷ Juliuscenter for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁸ Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
¹⁹ National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
²⁰ Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.

PMID: 38486357
DOI: 10.1093/ehjqcco/qcae021

Abstract

Aims: Recent trials have shown that low-dose colchicine (0.5 mg once daily) reduces major cardiovascular events in patients with acute and chronic coronary syndromes. We aimed to estimate the cost-effectiveness of low-dose colchicine therapy in patients with chronic coronary disease when added to standard background therapy.

Methods and results: This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, costs and quality of life obtained from the Low-dose Colchicine 2 (LoDoCo2) trial, as well as meta-analyses and public sources. In this trial, Low-dose colchicine was added to standard of care and compared to placebo. The main outcomes were cardiovascular events including myocardial infarction, stroke and coronary revascularisation, quality-adjusted life-year (QALY), the cost per QALY gained (incremental cost-effectiveness ratio), and net monetary benefit. In the model, low-dose colchicine therapy yielded 0.04 additional QALYs compared with standard of care at an incremental cost of €455 from a societal perspective and €729 from a healthcare perspective, resulting in a cost per QALY gained of €12,176/QALY from a societal perspective and €19,499/QALY from a healthcare perspective. Net monetary benefit was €1,414 from a societal perspective and €1,140 from a healthcare perspective. Low-dose colchicine has a 96% and 94% chance of being cost effective, from respectively a societal and healthcare perspective when using a willingness to pay of €50,000/QALY. Net monetary benefit would decrease below zero when annual low-dose colchicine costs would exceed an annual cost of €221 per patient.

Conclusion: Adding low-dose colchicine to standard of care in patients with chronic coronary disease is cost-effective according to commonly accepted thresholds in Europe and Australia and compares favourably in cost-effectiveness to other drugs used in chronic coronary disease.

Keywords: Cost-efficacy; chronic coronary disease; low-dose colchicine.