Background The CULPRIT-SHOCK trial compared two treatment strategies for patients with acute myocardial infarction
and multivessel coronary artery disease complicated by cardiogenic shock: (a) culprit vessel only percutaneous coronary
intervention (CO-PCI), with additional staged revascularisation if indicated, and (b) immediate multivessel PCI (MV-PCI).
Methods A German societal and national health service perspective was considered for three different analyses. The cost
utility analysis (CUA) estimated costs and quality adjusted life years (QALYs) based on a pre-trial decision analytic model
taking a lifelong time horizon. In addition, a within trial CUA estimated QALYs and costs for 1 year. Finally, the cost
effectiveness analysis (CEA) used the composite primary outcome, mortality and renal failure at 30-day follow-up, and the
within trial costs. Econometric and survival analysis on the trial data was used for the estimation of the model parameters.
Subgroup analysis was performed following an economic protocol.
Results The lifelong CUA showed an incremental cost effectiveness ratio (ICER), CO-PCI vs. MV-PCI, of €7010 per QALY
and a probability of CO-PCI being the most cost-effective strategy > 64% at a €30,000 threshold. The ICER for the within
trial CUA was €14,600 and the incremental cost per case of death/renal failure avoided at 30-day follow-up was €9010.
Cost-effectiveness improved with patient age and for those without diabetes.
Conclusions The estimates of cost-effectiveness for CO-PCI vs. MV-PCI have been shown to change depending on the time
horizon and type of economic evaluation performed. The results favoured a long-term horizon analysis for avoiding underestimation
of QALY gains from the CO-PCI arm.
