Introduction Emergency percutaneous coronary
intervention (PCI) of the culprit lesion for patients with
acute myocardial infarctions is an accepted practice. A
majority of patients present with multivessel disease with
additional relevant stenoses apart from the culprit lesion.
In haemodynamically stable patients, there is increasing
evidence from randomised trials to support the practice
of immediate complete revascularisation. However, in the
presence of cardiogenic shock, the optimal management
strategy for additional non-culprit lesions is unknown. A
multicentre randomised controlled trial, CULPRIT-SHOCK, is
examining whether culprit vessel only PCI with potentially
subsequent staged revascularisation is more effective
than immediate multivessel PCI. This paper describes the
intended economic evaluation of the trial.
Methods and analysis The economic evaluation will be
conducted using a pre-trial decision model and withintrial
analysis. The modelling-based analysis will provide
expected costs and health outcomes, and incremental
cost-effectiveness ratio over the lifetime for the cohort
of patients included in the trial. The within-trial analysis
will provide estimates of cost per life saved at 30 days
and in 1 year, and estimates of health-related quality of
life. Bootstrapping and cost-effectiveness acceptability
curves will be used to address any uncertainty around
these estimates. Different types of regression models
within a generalised estimating equation framework
will be used to examine how the total cost and
quality-adjusted life years are explained by patients’
characteristics, revascularisation strategy, country and
centre. The cost-effectiveness analysis will be from the
perspective of each country’s national health services,
where costs will be expressed in euros adjusted for
purchasing power parity.
