Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery
Background: Low-dose Colchicine therapy has demonstrated clinical benefit as secondary preventive therapy in patients with chronic coronary artery disease. While prior studies have reported its cost-effectiveness in this patient group, this has not yet been studied in post-coronary artery bypass gra...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | American Heart Journal Plus |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000837 |
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| author | Sai Rahul Ponnana Gauranga Mahalwar Joris Holtrop Steven H.J. Hageman Tong Zhang Santosh Kumar Sirasapalli Skanda Moorthy Zhuo Chen Jean-Eudes Dazard Sadeer Al-Kindi Yakov Elgudin Naveed Sattar Sanjay Rajagopalan Salil V. Deo |
| author_facet | Sai Rahul Ponnana Gauranga Mahalwar Joris Holtrop Steven H.J. Hageman Tong Zhang Santosh Kumar Sirasapalli Skanda Moorthy Zhuo Chen Jean-Eudes Dazard Sadeer Al-Kindi Yakov Elgudin Naveed Sattar Sanjay Rajagopalan Salil V. Deo |
| author_sort | Sai Rahul Ponnana |
| collection | DOAJ |
| description | Background: Low-dose Colchicine therapy has demonstrated clinical benefit as secondary preventive therapy in patients with chronic coronary artery disease. While prior studies have reported its cost-effectiveness in this patient group, this has not yet been studied in post-coronary artery bypass grafting (CABG) patients. Therefore, we evaluated the 5-year potential clinical benefit and lifetime cost-effectiveness of adding low-dose Colchicine to routine secondary preventive therapy among U.S. Veterans post-CABG. Methods: A discrete time-homogeneous, annual cycle, state-transition Markov Chain model was developed using MACE (myocardial infarction, stroke, coronary reintervention, and all-cause mortality) information from 27,443 U.S. Veterans who underwent CABG. Cost and utility estimates were sourced from peer-reviewed literature. Current secondary preventive therapy was compared with secondary preventive therapy + Colchicine over a 35-year period. Clinical benefit was extrapolated from a nationwide perspective. Cost-effectiveness was modeled by calculating incremental cost-effectiveness ratios (ICERs) across a wide range of willingness-to-pay (WTP) thresholds. Deterministic, probabilistic, and alternative real-world scenarios were modeled to evaluate real-world use. Results: In 150,000 isolated CABG patients who received surgery in 2019 across the U.S., Colchicine therapy could potentially reduce 8266 myocardial infarctions, 16,674 strokes, and 9472 coronary reinterventions over 5 years. Lifetime Colchicine therapy yielded a QALY gain of 0.74 and an ICER of $26,684 per QALY. Monte Carlo simulation supported these findings (median ICER: $19,598; IQR: $17,995–$20,921). Colchicine remained cost-effective at WTP thresholds >$20,000 per QALY, even with 5-year or mixed adherence. Conclusion: Adjunct life-long Colchicine therapy may reduce cardiovascular events at an acceptable additional cost post-CABG. |
| format | Article |
| id | doaj-art-53c0d949e7014fa980fa8dd177f6b55b |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-53c0d949e7014fa980fa8dd177f6b55b2025-08-20T04:02:50ZengElsevierAmerican Heart Journal Plus2666-60222025-09-015710058010.1016/j.ahjo.2025.100580Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgerySai Rahul Ponnana0Gauranga Mahalwar1Joris Holtrop2Steven H.J. Hageman3Tong Zhang4Santosh Kumar Sirasapalli5Skanda Moorthy6Zhuo Chen7Jean-Eudes Dazard8Sadeer Al-Kindi9Yakov Elgudin10Naveed Sattar11Sanjay Rajagopalan12Salil V. Deo13Harrington Heart and Vascular Institute, University Hospitals, Cleveland, USADepartment of Internal Medicine, Cleveland Clinic, Cleveland, USADepartment of Vascular Medicine, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Vascular Medicine, University Medical Center Utrecht, Utrecht, the NetherlandsHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USAHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USAHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USAHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USAHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USADivision of Cardiology, Houston Methodist Hospital, Houston, USAHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USA; Case School of Medicine, Case Western Reserve University, Cleveland, USASchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UKHarrington Heart and Vascular Institute, University Hospitals, Cleveland, USA; Case School of Medicine, Case Western Reserve University, Cleveland, USALouis Stokes Cleveland VA Medical Center, Cleveland, USA; Case School of Medicine, Case Western Reserve University, Cleveland, USA; School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Corresponding author at: Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA.; Correspoding author at: Surgical Services, Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USABackground: Low-dose Colchicine therapy has demonstrated clinical benefit as secondary preventive therapy in patients with chronic coronary artery disease. While prior studies have reported its cost-effectiveness in this patient group, this has not yet been studied in post-coronary artery bypass grafting (CABG) patients. Therefore, we evaluated the 5-year potential clinical benefit and lifetime cost-effectiveness of adding low-dose Colchicine to routine secondary preventive therapy among U.S. Veterans post-CABG. Methods: A discrete time-homogeneous, annual cycle, state-transition Markov Chain model was developed using MACE (myocardial infarction, stroke, coronary reintervention, and all-cause mortality) information from 27,443 U.S. Veterans who underwent CABG. Cost and utility estimates were sourced from peer-reviewed literature. Current secondary preventive therapy was compared with secondary preventive therapy + Colchicine over a 35-year period. Clinical benefit was extrapolated from a nationwide perspective. Cost-effectiveness was modeled by calculating incremental cost-effectiveness ratios (ICERs) across a wide range of willingness-to-pay (WTP) thresholds. Deterministic, probabilistic, and alternative real-world scenarios were modeled to evaluate real-world use. Results: In 150,000 isolated CABG patients who received surgery in 2019 across the U.S., Colchicine therapy could potentially reduce 8266 myocardial infarctions, 16,674 strokes, and 9472 coronary reinterventions over 5 years. Lifetime Colchicine therapy yielded a QALY gain of 0.74 and an ICER of $26,684 per QALY. Monte Carlo simulation supported these findings (median ICER: $19,598; IQR: $17,995–$20,921). Colchicine remained cost-effective at WTP thresholds >$20,000 per QALY, even with 5-year or mixed adherence. Conclusion: Adjunct life-long Colchicine therapy may reduce cardiovascular events at an acceptable additional cost post-CABG.http://www.sciencedirect.com/science/article/pii/S2666602225000837 |
| spellingShingle | Sai Rahul Ponnana Gauranga Mahalwar Joris Holtrop Steven H.J. Hageman Tong Zhang Santosh Kumar Sirasapalli Skanda Moorthy Zhuo Chen Jean-Eudes Dazard Sadeer Al-Kindi Yakov Elgudin Naveed Sattar Sanjay Rajagopalan Salil V. Deo Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery American Heart Journal Plus |
| title | Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| title_full | Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| title_fullStr | Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| title_full_unstemmed | Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| title_short | Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| title_sort | clinical benefit and cost effectiveness of adding life time low dose colchicine as secondary prevention following coronary artery bypass grafting surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000837 |
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