TY - JOUR
T1 - Cost-effectiveness of everolimus-versus paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization (from the SPIRIT-IV trial)
AU - Amin, Amit P.
AU - Reynolds, Matthew R.
AU - Lei, Yang
AU - Magnuson, Elizabeth A.
AU - Vilain, Katherine
AU - Durtschi, Amy J.
AU - Simonton, Charles A.
AU - Stone, Gregg W.
AU - Cohen, David J.
N1 - Funding Information:
Funding for the SPIRIT-IV trial and its economic analysis was provided by grants from Abbott Vascular, Inc. , Santa Clara, California. Dr. Cohen has received institutional research grant support from Boston Scientific , Eli Lilly , Daiichi Sankyo , Abbott Vascular , Medtronic , Schering-Plough , and Edwards Lifesciences . Dr. Cohen has also received consulting fees from Cordis and Medtronic and speaking honoraria from Eli Lilly and the Medicines Company. Dr. Magnuson has received grant support from Eli Lilly , Daiichi Sankyo , Sanofi-Aventis , and Bristol-Myers Squibb and has received lecture fees from Sanofi-Aventis and Bristol-Myers Squibb. Dr. Stone is a consultant for Abbott Vascular, Boston Scientific, and Medtronic.
PY - 2012/9/15
Y1 - 2012/9/15
N2 - Although several drug-eluting stents (DESs) have been shown to be economically attractive compared to bare-metal stents in patients at moderate to high risk of restenosis, little is known about the costeffectiveness of alternative DES designs, especially second-generation DESs. We therefore performed an economic substudy alongside the SPIRIT-IV trial, in which 3,687 patients undergoing single or multivessel percutaneous coronary intervention were randomized to receive second-generation everolimus-eluting stents (EESs; n = 2,458) or first-generation paclitaxel-eluting stents (PESs; n = 1,229). Costs through 2 years of follow-up were assessed from the perspective of the United States health care system. The primary cost-effectiveness end point was the incremental cost-effectiveness ratio assessed as cost per quality-adjusted life year gained. Over a 2-year period, use of EESs versus PESs led to a trend toward decreased overall repeat revascularization procedures (14.2 vs 16.2 per 100 subjects, p = 0.20) driven by a significant decrease in the number of target vessel revascularization procedures (8.2 vs 11.0 per 100 subjects, p = 0.02) but also a slight increase in the number of nontarget vessel revascularization procedures (6.0 vs 5.1 per 100 subjects, p = 0.37). Follow-up cardiovascular costs were decreased by $273/patient in the EES group (95% confidence interval for difference 1,048 less to 502 more, p = 0.49). Formal cost-effectiveness analysis based on these results demonstrated that the probability that EES was an economically attractive strategy (incremental cost-effectiveness ratio <$50,000/quality-adjusted life year gained) was 85.7%. These findings demonstrate that in patients undergoing percutaneous coronary intervention with DESs, use of EESs is economically attractive compared to PESs with improved clinical outcomes and lower overall medical care costs at 2 years.
AB - Although several drug-eluting stents (DESs) have been shown to be economically attractive compared to bare-metal stents in patients at moderate to high risk of restenosis, little is known about the costeffectiveness of alternative DES designs, especially second-generation DESs. We therefore performed an economic substudy alongside the SPIRIT-IV trial, in which 3,687 patients undergoing single or multivessel percutaneous coronary intervention were randomized to receive second-generation everolimus-eluting stents (EESs; n = 2,458) or first-generation paclitaxel-eluting stents (PESs; n = 1,229). Costs through 2 years of follow-up were assessed from the perspective of the United States health care system. The primary cost-effectiveness end point was the incremental cost-effectiveness ratio assessed as cost per quality-adjusted life year gained. Over a 2-year period, use of EESs versus PESs led to a trend toward decreased overall repeat revascularization procedures (14.2 vs 16.2 per 100 subjects, p = 0.20) driven by a significant decrease in the number of target vessel revascularization procedures (8.2 vs 11.0 per 100 subjects, p = 0.02) but also a slight increase in the number of nontarget vessel revascularization procedures (6.0 vs 5.1 per 100 subjects, p = 0.37). Follow-up cardiovascular costs were decreased by $273/patient in the EES group (95% confidence interval for difference 1,048 less to 502 more, p = 0.49). Formal cost-effectiveness analysis based on these results demonstrated that the probability that EES was an economically attractive strategy (incremental cost-effectiveness ratio <$50,000/quality-adjusted life year gained) was 85.7%. These findings demonstrate that in patients undergoing percutaneous coronary intervention with DESs, use of EESs is economically attractive compared to PESs with improved clinical outcomes and lower overall medical care costs at 2 years.
UR - http://www.scopus.com/inward/record.url?scp=84865518812&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2012.05.006
DO - 10.1016/j.amjcard.2012.05.006
M3 - Article
C2 - 22651880
AN - SCOPUS:84865518812
SN - 0002-9149
VL - 110
SP - 765
EP - 770
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 6
ER -