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Title: The cost-effectiveness of guideline-driven use of drug-eluting stents: propensity-score matched analysis of a seven-year multicentre experience.
Austin Authors: Ariyaratne, Thathya V;Ademi, Zanfina;Ofori-Asenso, Richard;Huq, Molla M;Duffy, Stephen J;Yan, Bryan P;Ajani, Andrew E;Clark, David J ;Billah, Baki;Brennan, Angela L;New, Gishel;Andrianopoulos, Nick;Reid, Christopher M
Affiliation: Cardiovascular Medicine, Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
Deceased Author, Department of Cardiology, Box Hill Hospital, Box Hill, VIC, Australia
School of Public Health and Preventive Medicine, Monash University, VIC, Australia
Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
Department of Medicine, University of Melbourne, VIC, Australia
Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
Royal Melbourne Hospital, Parkville, VIC, Australia
School of Public Health, Curtin University, Perth, WA, Australia
Issue Date: Mar-2020
Date: 2019-12-24
Publication information: Current Medical Research and Opinion 2020; 36(3): 419-426
Abstract: Background:In routine clinical practice, the implantation of a drug-eluting stent (DES) versus a bare metal stent (BMS) for percutaneous coronary intervention (PCI) has been guided by criteria for appropriate use. The cost-effectiveness (CE) of adopting these guidelines, however, is not clear, and was investigated from the perspective of the Australian healthcare payer. Methods and Results: Baseline and 12-month follow-up data of 12,710 PCI patients enrolled in the Melbourne Interventional Group (MIG) registry between 2004 and 2011 were analysed. Costs inputs were derived from a clinical costing database and published sources. Propensity-score-matching was performed for DES and BMS groups within sub-groups. Incremental cost-effectiveness ratios (ICERs) were evaluated for all patients, and sub-groups of patients with '0', 1, 2, or ≥3 indications for a DES. While the incremental cost per TVR avoided for these groups were $24,683, $44,635, $33,335, and $23,788, respectively, for those with ≥3 indications, DES compared with BMS was associated with cost savings. At willingness to pay thresholds of $45,000-$75,000, probability of cost-effectiveness of DES for the overall cohort was 71-91%, '0' indications, 49-67%, 1 indication, 56-82%, 2 indications, 70-90%, and ≥3 indications, 97-99%. Conclusions: The cost-effectiveness of DES compared with BMS increased with increasing risk profile of patients from those who had 1, 2, to ≥3 indications for a DES. When compared with BMS, DES was least cost effective among patients with '0' indications for a DES. Based on these results, selective use of DES implantation is supported. These findings may be useful for evidence-based clinical decision-making.
DOI: 10.1080/03007995.2019.1708288
Journal: Current Medical Research and Opinion
PubMed URL: 31870180
Type: Journal Article
Subjects: bare-metal stents
drug-eluting stents
risk factors
target-vessel revascularisation
Appears in Collections:Journal articles

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