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Establishing the cost-effectiveness of percutaneous coronary intervention for chronic total occlusion in stable

Hemal Gada1, Patrick L Whitlow, Thomas H Marwick

  • 1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Heart (British Cardiac Society)
|October 6, 2012
PubMed

Insights

Percutaneous coronary intervention for chronic total occlusions (CTO-PCI) is cost-effective for severe chronic stable angina, improving quality of life. This procedure offers a favorable economic profile compared to optimal medical treatment (OMT).

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • Chronic stable angina (CSA) management involves percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs), showing symptom improvement and potential survival benefits.
  • The economic value of CTO-PCI compared to optimal medical treatment (OMT) for CSA remains underexplored.

Purpose of the Study:

  • To evaluate the cost-effectiveness of CTO-PCI versus OMT in patients with chronic stable angina.

Main Methods:

  • A Markov decision-analytic model was developed using literature and clinical data for transition probabilities, utilities, and costs.
  • Cost-effectiveness was assessed by comparing quality-adjusted life-years (QALYs) and total costs between CTO-PCI and OMT strategies.
  • Sensitivity analyses were performed to identify key factors influencing the model's outcome.

Main Results:

  • CTO-PCI incurred higher costs (US$31,512) but yielded more QALYs (2.38) compared to OMT (US$27,805; 1.99 QALYs), resulting in a cost-effectiveness ratio of US$9,505 per QALY.
  • Sensitivity analyses indicated that patient utilities and post-procedural quality of life were the most significant drivers of cost-effectiveness.
  • Procedural success had a limited impact on the model's outcome within specific utility thresholds.

Conclusions:

  • CTO-PCI is a cost-effective strategy for patients with severe symptoms of chronic stable angina.
  • Future appropriateness criteria for CTO-PCI should incorporate quality-of-life metrics to guide clinical decision-making.
Abstract

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