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Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention

Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention
Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention

Objectives: to determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction.

Methods: an economic evaluation of a multicenter randomized trial was conducted, comparing complete revascularization at index admission to IRA-only P-PCI in patients with multivessel disease (12-month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital length of stay, and any subsequent re-admissions) were estimated. Outcomes were major adverse cardiac events (MACEs, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularization) and quality-adjusted life-years (QALYs) derived from the three-level EuroQol five-dimensional questionnaire. Multiple imputation was undertaken. The mean incremental cost and effect, with associated 95% confidence intervals, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated.

Results: on the basis of 296 patients, the mean incremental overall hospital cost for complete revascularization was estimated to be -£215.96 (-£1390.20 to £958.29), compared with IRA-only, with a per-patient mean reduction in MACEs of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (-0.019 to 0.041). According to the cost-effectiveness acceptability curve, the probability of complete revascularization being cost-effective was estimated to be 72.0% at a willingness-to-pay threshold value of £20,000 per QALY.

Conclusions: complete revascularization at index admission was estimated to be more effective (in terms of MACEs and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularization thereby dominated IRA-only). There was, however, some uncertainty associated with this decision.

Aged, Coronary Artery Disease/economics, Cost-Benefit Analysis, Follow-Up Studies, Hospital Costs/statistics & numerical data, Humans, Length of Stay, Male, Middle Aged, Myocardial Revascularization/economics, Percutaneous Coronary Intervention/economics, Probability, Quality-Adjusted Life Years, ST Elevation Myocardial Infarction/economics, Surveys and Questionnaires
1098-3015
745-751
Barton, Garry R
bf3455b3-9bee-4af6-94e8-930b2a383b33
Irvine, Lisa
3180e023-ae18-41fb-980b-e299973e5e77
Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
McCann, Gerry P
8e61a5f4-0764-4adf-bc9c-5abba82425fc
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Gershlick, Anthony H
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
CvLPRIT Investigators
Barton, Garry R
bf3455b3-9bee-4af6-94e8-930b2a383b33
Irvine, Lisa
3180e023-ae18-41fb-980b-e299973e5e77
Flather, Marcus
f1c158fe-9da3-4604-adfc-a5f8db10d5d3
McCann, Gerry P
8e61a5f4-0764-4adf-bc9c-5abba82425fc
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Gershlick, Anthony H
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9

Barton, Garry R, Irvine, Lisa, Flather, Marcus, McCann, Gerry P, Curzen, Nick and Gershlick, Anthony H , CvLPRIT Investigators (2017) Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention. Value in Health, 20 (6), 745-751. (doi:10.1016/j.jval.2017.02.002).

Record type: Article

Abstract

Objectives: to determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction.

Methods: an economic evaluation of a multicenter randomized trial was conducted, comparing complete revascularization at index admission to IRA-only P-PCI in patients with multivessel disease (12-month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital length of stay, and any subsequent re-admissions) were estimated. Outcomes were major adverse cardiac events (MACEs, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularization) and quality-adjusted life-years (QALYs) derived from the three-level EuroQol five-dimensional questionnaire. Multiple imputation was undertaken. The mean incremental cost and effect, with associated 95% confidence intervals, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated.

Results: on the basis of 296 patients, the mean incremental overall hospital cost for complete revascularization was estimated to be -£215.96 (-£1390.20 to £958.29), compared with IRA-only, with a per-patient mean reduction in MACEs of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (-0.019 to 0.041). According to the cost-effectiveness acceptability curve, the probability of complete revascularization being cost-effective was estimated to be 72.0% at a willingness-to-pay threshold value of £20,000 per QALY.

Conclusions: complete revascularization at index admission was estimated to be more effective (in terms of MACEs and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularization thereby dominated IRA-only). There was, however, some uncertainty associated with this decision.

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More information

e-pub ahead of print date: 22 March 2017
Published date: June 2017
Additional Information: Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Keywords: Aged, Coronary Artery Disease/economics, Cost-Benefit Analysis, Follow-Up Studies, Hospital Costs/statistics & numerical data, Humans, Length of Stay, Male, Middle Aged, Myocardial Revascularization/economics, Percutaneous Coronary Intervention/economics, Probability, Quality-Adjusted Life Years, ST Elevation Myocardial Infarction/economics, Surveys and Questionnaires

Identifiers

Local EPrints ID: 435588
URI: http://eprints.soton.ac.uk/id/eprint/435588
ISSN: 1098-3015
PURE UUID: c1113895-4264-46e6-8c94-4c4ab5a181c9

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Date deposited: 12 Nov 2019 17:30
Last modified: 16 Dec 2019 17:31

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Contributors

Author: Garry R Barton
Author: Lisa Irvine
Author: Marcus Flather
Author: Gerry P McCann
Author: Nick Curzen
Author: Anthony H Gershlick

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