Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents: Results from a patient level meta-analysis of randomized trials

Nicole Ferko, Giuseppe Ferrante, James T Hasegawa, Tanya Schikorr, Ireena M Soleas, John B Hernandez, Manel Sabaté, Christoph Kaiser, Salvatore Brugaletta, Jose Maria de la Torre Hernandez, Soeren Galatius, Angel Cequier, Franz Eberli, Adam de Belder, Patrick W Serruys, Marco Valgimigli

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI).

OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI.

METHODS: A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis.

RESULTS: The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99% chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS.

CONCLUSIONS: Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)994-1002
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume89
Issue number6
DOIs
Publication statusPublished - May 2017

Fingerprint

Chromium
Percutaneous Coronary Intervention
Cobalt
Cost-Benefit Analysis
Stents
Meta-Analysis
Metals
Costs and Cost Analysis
Drug-Eluting Stents
Quality-Adjusted Life Years
clopidogrel
Everolimus
Cost Savings
Medicare
Catheterization

Keywords

  • Aged
  • Cardiovascular Agents
  • Chromium Alloys
  • Coronary Artery Disease
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug-Eluting Stents
  • Everolimus
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Markov Chains
  • Medicare
  • Models, Economic
  • Percutaneous Coronary Intervention
  • Prosthesis Design
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic
  • Time Factors
  • Treatment Outcome
  • United States
  • Journal Article
  • Meta-Analysis

Cite this

Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents : Results from a patient level meta-analysis of randomized trials. / Ferko, Nicole; Ferrante, Giuseppe; Hasegawa, James T; Schikorr, Tanya; Soleas, Ireena M; Hernandez, John B; Sabaté, Manel; Kaiser, Christoph; Brugaletta, Salvatore; de la Torre Hernandez, Jose Maria; Galatius, Soeren; Cequier, Angel; Eberli, Franz; de Belder, Adam; Serruys, Patrick W; Valgimigli, Marco.

In: Catheterization and Cardiovascular Interventions, Vol. 89, No. 6, 05.2017, p. 994-1002.

Research output: Contribution to journalArticle

Ferko, N, Ferrante, G, Hasegawa, JT, Schikorr, T, Soleas, IM, Hernandez, JB, Sabaté, M, Kaiser, C, Brugaletta, S, de la Torre Hernandez, JM, Galatius, S, Cequier, A, Eberli, F, de Belder, A, Serruys, PW & Valgimigli, M 2017, 'Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents: Results from a patient level meta-analysis of randomized trials', Catheterization and Cardiovascular Interventions, vol. 89, no. 6, pp. 994-1002. https://doi.org/10.1002/ccd.26700
Ferko, Nicole ; Ferrante, Giuseppe ; Hasegawa, James T ; Schikorr, Tanya ; Soleas, Ireena M ; Hernandez, John B ; Sabaté, Manel ; Kaiser, Christoph ; Brugaletta, Salvatore ; de la Torre Hernandez, Jose Maria ; Galatius, Soeren ; Cequier, Angel ; Eberli, Franz ; de Belder, Adam ; Serruys, Patrick W ; Valgimigli, Marco. / Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents : Results from a patient level meta-analysis of randomized trials. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 89, No. 6. pp. 994-1002.
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abstract = "BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI).OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI.METHODS: A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis.RESULTS: The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99{\%} chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS.CONCLUSIONS: Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. {\circledC} 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.",
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TY - JOUR

T1 - Cost-effectiveness of percutaneous coronary intervention with cobalt-chromium everolimus eluting stents versus bare metal stents

T2 - Results from a patient level meta-analysis of randomized trials

AU - Ferko, Nicole

AU - Ferrante, Giuseppe

AU - Hasegawa, James T

AU - Schikorr, Tanya

AU - Soleas, Ireena M

AU - Hernandez, John B

AU - Sabaté, Manel

AU - Kaiser, Christoph

AU - Brugaletta, Salvatore

AU - de la Torre Hernandez, Jose Maria

AU - Galatius, Soeren

AU - Cequier, Angel

AU - Eberli, Franz

AU - de Belder, Adam

AU - Serruys, Patrick W

AU - Valgimigli, Marco

N1 - © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

PY - 2017/5

Y1 - 2017/5

N2 - BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI).OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI.METHODS: A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis.RESULTS: The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99% chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS.CONCLUSIONS: Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

AB - BACKGROUND: Second-generation drug eluting stents (DES) may reduce costs and improve clinical outcomes compared to first-generation DES with improved cost-effectiveness when compared to bare metal stents (BMS). We aimed to conduct an economic evaluation of a cobalt-chromium everolimus eluting stent (Co-Cr EES) compared with BMS in percutaneous coronary intervention (PCI).OBJECTIVE: To conduct a cost-effectiveness analysis (CEA) of a cobalt-chromium everolimus eluting stent (Co-Cr EES) versus BMS in PCI.METHODS: A Markov state transition model with a 2-year time horizon was applied from a US Medicare setting with patients undergoing PCI with Co-Cr EES or BMS. Baseline characteristics, treatment effects, and safety measures were taken from a patient level meta-analysis of 5 RCTs (n = 4,896). The base-case analysis evaluated stent-related outcomes; a secondary analysis considered the broader set of outcomes reported in the meta-analysis.RESULTS: The base-case and secondary analyses reported an additional 0.018 and 0.013 quality-adjusted life years (QALYs) and cost savings of $236 and $288, respectively with Co-Cr EES versus BMS. Results were robust to sensitivity analyses and were most sensitive to the price of clopidogrel. In the probabilistic sensitivity analysis, Co-Cr EES was associated with a greater than 99% chance of being cost saving or cost effective (at a cost per QALY threshold of $50,000) versus BMS.CONCLUSIONS: Using data from a recent patient level meta-analysis and contemporary cost data, this analysis found that PCI with Co-Cr EES is more effective and less costly than PCI with BMS. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

KW - Aged

KW - Cardiovascular Agents

KW - Chromium Alloys

KW - Coronary Artery Disease

KW - Cost-Benefit Analysis

KW - Drug Costs

KW - Drug-Eluting Stents

KW - Everolimus

KW - Female

KW - Health Care Costs

KW - Humans

KW - Male

KW - Markov Chains

KW - Medicare

KW - Models, Economic

KW - Percutaneous Coronary Intervention

KW - Prosthesis Design

KW - Quality-Adjusted Life Years

KW - Randomized Controlled Trials as Topic

KW - Time Factors

KW - Treatment Outcome

KW - United States

KW - Journal Article

KW - Meta-Analysis

U2 - 10.1002/ccd.26700

DO - 10.1002/ccd.26700

M3 - Article

C2 - 27527508

VL - 89

SP - 994

EP - 1002

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 6

ER -