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 journalArticlepeer-review

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

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

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