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Meta-Analysis
. 2017 May;89(6):994-1002.
doi: 10.1002/ccd.26700. Epub 2016 Aug 16.

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  1 , Giuseppe Ferrante  2 , James T Hasegawa  3 , Tanya Schikorr  3 , Ireena M Soleas  1 , John B Hernandez  4 , Manel Sabaté  5 , Christoph Kaiser  6 , Salvatore Brugaletta  5 , Jose Maria de la Torre Hernandez  7 , Soeren Galatius  8 , Angel Cequier  9 , Franz Eberli  10 , Adam de Belder  11 , Patrick W Serruys  12 , Marco Valgimigli  13
Affiliations
Meta-Analysis

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 et al. Catheter Cardiovasc Interv. 2017 May.

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.

Keywords: bare metal stent; cost-effectiveness; drug-eluting stent; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Overview of the model structure. The model captured both base‐case (i.e., TVR, TVR‐related MI, ST, and cardiac mortality) and secondary analysis (i.e., TVR, MI, ST, all‐cause death) outcomes. MI = myocardial infarction; ST = stent thrombosis; TVR = target vessel revascularization.
Figure 2
Figure 2
Results of the probabilistic sensitivity analysis on the cost‐effectiveness scatter plot for the base‐case analysis (A) and the secondary analysis (B) 28. QALY = quality‐adjusted life year; USD = United States dollars.
Figure 3
Figure 3
Results of the probabilistic sensitivity analysis using cost‐effectiveness acceptability curves for the base‐case analysis (A) and the secondary analysis (B) 28. BMS = bare‐metal stent; Co‐Cr EES = cobalt chromium everolimus‐eluting stent; USD = United States dollars.
See this image and copyright information in PMC

Comment in

  • Dollars and stents: A brave new world.
    Krishnan SK, Dean LS. Krishnan SK, et al. Catheter Cardiovasc Interv. 2017 May;89(6):1003-1004. doi: 10.1002/ccd.27077. Catheter Cardiovasc Interv. 2017. PMID: 28488405

References

    1. Windecker S, Juni P. The drug‐eluting stent saga. Circulation 2009; 119:653–656. - PubMed
    1. Sabate M, Raber L, Heg D, Brugaletta S, Kelbaek H, Cequier A, Ostojic M, Iniquez A, Tuller D, Serra A, Baumbach A, von Birgelen C, Hernandez‐Antolin R, Roffi M, Mainar V, Valgimigli M, Serruys PW, Juni P, Windecker S. Comparison of newer‐generation drug‐eluting with bare‐metal stents in patients with acute ST‐segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience‐V stent in Acute Myocardial INfArcTION) and COMFORTABLE‐AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST‐Elevation Myocardial Infarction) trials. JACC Cardiovasc Interv 2014; 7:55–63. - PubMed
    1. Palmerini T, Benedetto U, Biondi‐Zoccai G, Della Riva D, Bacchi‐Reggiani L, Smits PC, Vlachojannis GJ, Jensen LO, Christiansen EH, Berencsi K, Valgimigli M, Orlandi C, Petrou M, Rapezzi C, Stone GW. Long‐Term Safety of Drug‐Eluting and Bare‐Metal Stents: Evidence From a Comprehensive Network Meta‐Analysis. J Am Coll Cardiol 2015; 65:2496–2507. - PubMed
    1. Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, Doostzadeh J, Cao S, Simonton CA, Sudhir K, Lansky AJ, Cutlip DE, Kereiakes DJ; SPIRIT IV Investigators. Everolimus‐eluting versus paclitaxel‐eluting stents in coronary artery disease. N Engl J Med 2010; 362:1663–1674. - PubMed
    1. Valgimigli M, Sabaté M, Kaiser C, Brugaletta S, de la Torre Hernandez JM, Galatius S, Cequier A, Eberli F, de Belder A, Serruys PW, Ferrante G. Effects of cobalt‐chromium everolimus eluting stents or bare metal stent on fatal and non‐fatal cardiovascular events: patient level meta‐analysis. BMJ 2014; 349:g6427 - PMC - PubMed

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