The role of ranolazine in managing chronic coronary syndrome: a synthesis of clinical outcomes and health economic modelling

Abstract

Patients with chronic coronary syndrome (CCS) frequently experience ongoing angina, diminished quality of life (QoL), and face a heightened need for revascularisation procedures. The present analysis aimed to consolidate clinical and health economic data regarding the use of ranolazine in CCS. By combining predictive modelling with systematic review findings, we assessed the drug's influence on patient symptoms, overarching cardiovascular events, and financial viability. We conducted a comprehensive meta-analysis and systematic review of existing clinical and cost-effectiveness data. To forecast five-year treatment trajectories and disease advancement from a healthcare payer's viewpoint, a Markov state-transition model was constructed. This simulation accounted for Canadian Cardiovascular Society angina grades I through IV, the occurrence of acute coronary syndromes (ACS), utilisation of optimal medical therapy (OMT), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and mortality rates. Primary endpoints evaluated were quality-adjusted life-years (QALYs), additional expenditures, and the duration of life lived free from ACS or revascularisation interventions. Treatment with ranolazine led to a substantial decrease in the need for CABG by 37% (risk ratio [RR] = 0.63, 95% confidence interval [CI]: 0.53–0.75), PCI by 54% (RR = 0.46, 95% CI: 0.12–1.76), and overall revascularisation interventions by 17% (RR = 0.83, 95% CI: 0.75–0.93). Patients demonstrated enhanced functional capacity, noting extended exercise times (+42.9 seconds), postponed angina onset (+28.9 seconds), and a delay in ST-segment depression (+28.0 seconds). Furthermore, self-reported metrics across the Seattle Angina Questionnaire showed marked improvement. From an economic standpoint, incremental cost-utility ratios were calculated at 36,356 United States dollars (USD) per QALY after one year and 40,505 USD per QALY at the five-year mark, consistently staying under the accepted 50,000 USD willingness-to-pay threshold. Every month of ranolazine administration yielded an additional two weeks without the need for procedures, accumulating to 1.8 years of procedure-free time over a five-year span. For every 1000 individuals treated, the therapy averted 1.41 CABG operations, 23.21 PCI interventions, and 36.15 ACS occurrences. Ranolazine effectively lowers the incidence of myocardial infarction (MI) and the demand for revascularisation while enhancing patients' quality of life, symptom control, and exercise capabilities. Offering both sustained cardiovascular benefits and strong cost-effectiveness, these results endorse the incorporation of ranolazine into standard CCS treatment protocols and broader healthcare resource strategies.