Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery

Abstract

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.