Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention

Barton, Garry R., Irvine, Lisa, Flather, Marcus, McCann, Gerry P., Curzen, Nick, Gerschlick, Anthony H. and , CVLPRIT trial investigators (2017) Economic evaluation of complete revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention. Value in Health, 20 (6). 745–751. ISSN 1098-3015

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Abstract

Objective: To determine the cost-effectiveness of complete revascularisation at index admission compared to infarct-related artery (IRA) treatment only, in patients with multi-vessel disease undergoing Primary percutaneous coronary intervention (P-PCI) for ST-segment elevation Myocardial Infarction (STEMI). Methods: Economic evaluation of a multi-centre randomised trial comparing complete revascularisation at index admission to IRA-only P-PCI in patients with multi-vessel disease (12 month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital stay and any subsequent readmissions) were estimated. Outcomes were major adverse cardiac events (MACE, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularisation) and quality-adjusted life years (QALYs) derived from the EQ-5D-3L. Multiple imputation was undertaken. The mean incremental cost and effects, with associated 95% confidence intervals (95%CI), the incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability curve (CEAC) were estimated. Results: Based on 296 patients, the mean incremental overall hospital cost for complete revascularisation was estimated to be –£215.96 (–£1,390.20 to £958.29), compared to IRA-only, with a per-patient mean reduction in MACE events of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (-0.019 to 0.041). According to the CEAC, the probability of complete revascularisation being cost-effective was estimated to be 72.0% at willingness to pay of £20,000 per QALY. Conclusions: Complete revascularisation at index admission was estimated to be more effective (in terms of MACE and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularisation thereby dominated IRA-only). There was, however, some uncertainty associated with this decision.

Item Type: Article
Uncontrolled Keywords: economic evaluation,myocardial infarction,revascularization,percutaneous coronary intervention
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 09 Feb 2017 09:36
Last Modified: 22 Apr 2020 02:42
URI: https://ueaeprints.uea.ac.uk/id/eprint/62397
DOI: 10.1016/j.jval.2017.02.002

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