Pericarditis cost-effectiveness of therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Hafiz M. Ahmed, M.D.[3]
Overview
Formal cost-effectiveness analyses specific to pericarditis therapies are limited. However, available data suggest that colchicine, as a low-cost generic medication, is highly cost-effective when added to NSAID therapy for both acute and recurrent pericarditis, given its ability to halve recurrence rates and significantly reduce hospitalizations. Anti-IL-1 agents (rilonacept, anakinra) are substantially more expensive but may offset costs in patients with multiple recurrences by reducing emergency department visits, hospitalizations, corticosteroid-related complications, and work loss. Recurrent pericarditis carries a significant economic burden, with mean total healthcare costs nearly twice as high in patients with multiple recurrences compared with those without recurrence.
Cost-effectiveness of Therapy
Economic Burden of Recurrent Pericarditis
- Recurrent pericarditis imposes a substantial economic burden. A retrospective analysis of a privately insured United States population found that among patients with multiple recurrences, the median disease duration was 2.84 years. Mean total healthcare costs were significantly higher in patients with multiple recurrences compared with those without recurrence ($2,728 vs. $1,568 per patient per month; cost ratio 1.74), driven primarily by higher hospitalization costs ($1,180 vs. $420 per patient per month; cost ratio 2.81). Mean work loss costs were also significantly higher in the multiple recurrences group ($696 vs. $169 per patient per month; cost ratio 4.12). The mean cost of the first episode was $19,189, with subsequent recurrences ranging from $2,089 to $7,366 per episode.
- Pericarditis accounts for approximately 5% of emergency department visits for nonischemic chest pain in North America and Western Europe, and an estimated 40,000 patients in the United States have recurrent pericarditis. After a first recurrence, up to 50% of patients experience subsequent flares, and the mean duration of disease in difficult-to-treat patients can extend to 4.7 to 6.2 years, adding substantially to morbidity and healthcare costs.
Colchicine
- Colchicine is a low-cost generic medication (typically less than $1 per day) that has been shown in multiple randomized trials to reduce pericarditis recurrence by approximately 50% (number needed to treat of 5 for multiple recurrences) and to significantly reduce hospitalization rates. In the ICAP trial, colchicine reduced the hospitalization rate from 14.2% to 5.0% (p = 0.02) when added to conventional anti-inflammatory therapy. Given its low cost and demonstrated ability to reduce recurrences, hospitalizations, and symptom persistence, colchicine is likely highly cost-effective as adjunctive first-line therapy for both acute and recurrent pericarditis.
Anti-IL-1 Agents (Rilonacept, Anakinra, Goflikicept)
- Anti-IL-1 agents are substantially more expensive than conventional therapies. Rilonacept (Arcalyst), the only FDA-approved anti-IL-1 agent for recurrent pericarditis, has an estimated annual cost of approximately $200,000 or more. Anakinra (Kineret), used off-label for recurrent pericarditis, has a lower annual cost but still represents a significant expense compared with colchicine and NSAIDs.
- Despite their high acquisition cost, anti-IL-1 agents may provide economic value in the subset of patients with multiple recurrences who are colchicine-resistant and corticosteroid-dependent. In the RHAPSODY trial, rilonacept reduced recurrence from 74% to 6.7%, and an international registry of 224 patients treated with anakinra demonstrated reduced emergency department visits and hospitalizations. By preventing recurrent flares, reducing hospitalizations, enabling corticosteroid discontinuation (and thereby avoiding corticosteroid-related complications such as diabetes, osteoporosis, and infections), and reducing work loss, these agents may partially offset their high acquisition cost in appropriately selected patients.
- Formal cost-effectiveness analyses comparing anti-IL-1 agents with corticosteroids or other immunosuppressive strategies in recurrent pericarditis are needed to better define their value.
Corticosteroids
- Corticosteroids are inexpensive but are associated with a high rate of recurrence when used in first-episode pericarditis and carry significant long-term side effects (weight gain, hyperglycemia, osteoporosis, adrenal suppression, increased infection risk) that may increase downstream healthcare costs. The 2025 ACC Expert Consensus Statement recommends anti-IL-1 agents over corticosteroids as escalation therapy for patients with the inflammatory phenotype, in part because of the adverse effect profile and recurrence risk associated with corticosteroids.
Pericardiectomy
- Radical pericardiectomy on cardiopulmonary bypass is a last-resort option with operative mortality rates of 6% to 12% at major referral centers. The high procedural cost and significant morbidity make it a cost-effective option only in patients who have failed all pharmacological therapies or have contraindications to medical management.
Outpatient Management
- The 2025 ACC Expert Consensus Statement and prior guidelines support outpatient management of uncomplicated acute pericarditis, which avoids the cost of hospitalization. Outpatient treatment with NSAIDs and colchicine is safe and effective for low-risk patients, and this approach is inherently cost-effective compared with inpatient management [1].
References
- ↑ Wang, T. K. M., Klein, A. L., Cremer, P. C., Imazio, M., Kohnstamm, S., Luis, S. A., Mardigyan, V., Mukherjee, M., Ordovas, K., Vakamudi, S., & Wohlford, G. F. (2025). 2025 concise clinical guidance: An ACC expert consensus statement on the diagnosis and management of pericarditis: A report of the American college of cardiology solution set oversight committee. Journal of the American College of Cardiology, 86(25), 2691–2719. https://doi.org/10.1016/j.jacc.2025.05.023