AIMS: In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy. METHODS AND RESULTS: A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy. CONCLUSION: Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.

ANMCO Research Center Via La Marmora 34 50121 Firenze Italy

Bellevue Medical Center Qanater Zubayda Mansouriyeh Mansourieh Metn District Beirut Lebanon

Cardiovascular Center Na Homolce Hospital Roentgenova 2 150 00 Prague Czech Republic

Centre de recherche du Centre hospitalier de l'Université de Montréal 900 St Denis St Montreal Quebec H2X 0A9 Canada

Centre Hospitalier Régional de Lanaudière 1000 Sainte Anne Blvd Saint Charles Borromée Quebec J6E 6J2 Canada

Deutsches Herzzentrum München Technische Universität München Munich Institute of Epidemiology and Medical Biometry University of Ulm Ulm Lazarettstr 36 D 80636 Munchen Germany

Estudios Clinicos Latinoamerica Paraguay 160 2000 Rosario Argentina

Fattouma Bourguiba University Hospital 5000 Monastir Tunisia

H La Paz IdiPaz UAM Ciber CV Madrid La Paz University Hospital Paseo de la Castellana 261 28046 Madrid Spain

Logimetrix Inc 3600 Rhodes Drive Windsor Ontario N8W 5A4 Canada

Montreal Heart Institute Université de Montréal 5000 Belanger Street Montréal Québec H1T 1C8 Canada

San Francisco General Hospital Zuckerberg San Francisco General Hospital 1001 Potrero Avenue San Francisco CA 94110 USA

Santa Maria University Hospital Centro Académico de Medicina de Lisboa Centro Cardiovascular da Universidade de Lisboa Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal

The Montreal Health Innovations Coordinating Center 4100 Molson St Suite 400 Montreal Quebec H1Y 3N1 Canada

Université de Montpellier INSERM CNRS CHU de Montpellier Cardiology Department CHU Arnaud de Villeneuve 371 avenue du Doyen Gaston Giraud 34090 Montpellier France

University of Glasgow and NHS Glasgow Clinical Research Facility 126 University Pl University of Glasgow Glasgow G12 8TA Scotland UK

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