Economic evaluation of the impact of nicorandil in angina (IONA) trial

A. Walker, J. McMurray, S. Stewart, W. Berger, A. D. McMahon, H. Dargie, K. Fox, S. Hillis, N. J.K. Henderson, I. Ford

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14 Citations (Scopus)


Objective: To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit. Design: Cost effectiveness analysis Setting: Based on results of the IONA (impact of nicorandil on angina) trial. Patients: Patients with angina fulfilling the entry criteria for the IONA trial Interventions: In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone. Main outcome measures: Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial. Results: The net cost for each additional IONA trial end point averted was -£5 (-€7). The net cost for each case of acute coronary syndrome averted was -£8 (-€12). The net cost for each event-free survivor was -£5 (-€7). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to £567 (€835), £886 (€1305), and £516 (€760), respectively. Conclusions: A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably.

Original languageEnglish
Pages (from-to)619-624
Number of pages6
Issue number5
Publication statusPublished - 1 May 2006
Externally publishedYes


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